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THE  LIBRARY 
OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


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NATIONAL  ACADEMY  OF  SCIENCES 

OF  THE   UNITED  STATES  OF  AMERICA 


BIOGRAPHICAL  MEMOIRS 

PART   OF   VOLUME   VIII 


BIOGRAPHICAL  MEMOIR 

OF 

JOHN  SHAW  BILLINGS 
I838-I9I3 


S.  WEIR  MITCHELL 


THE  SCIENTIFIC  WORK  OF  JOHN  SHAW  BILLINGS 


BY 

FIELDING  H.  GARRISON 


3SENTED   TO   THE   ACADEMY    AT   THE    ANNUAL   A\EET1NG.    I9>6 


CITY  OF  WASHINGTON 

PUBLISHED  BY  THE  NATIONAL  ACADEMY  OF  SCIENCES 

August,  1917 


MEMOIR  OF  JOHN  SHAW  BILLINGS 

BY  S.   WEIR  MITCHELL. 


It  has  been  the  custom  of  the  National  Academy  of  Sciences 
to  commemorate  in  memoirs  those  whom  death  has  removed 
from  its  ranks.  Since  the  lives  of  men  of  science  are  little 
known  except  to  those  engaged  in  their  own  lines  of  research, 
some  record  is  the  more  to  be  desired  of  one  who  illustrated 
the  fact  that  scientific  capacity  may  exist  with  varied  ability  for 
the  conduct  of  large  affairs.  This  combination  of  talents  has 
been  often  found  in  the  ranks  of  the  Academy,  although,  in  the 
belief  of  the  public,  the  man  of  science  is  presumed  to  be  inca- 
pable of  the  successful  management  of  commercial  business. 

The  many  tasks  to  which  his  life  of  work  summoned  the 
subject  of  this  memoir  have  become,  since  his  death,  for  the 
first  time  so  widely  known  that  it  is  unnecessary  for  me  to  do 
more  than  to  put  on  paper  a  brief  summary  of  his  career  and 
the  reasons  for  his  election  to  this  distinguished  body  of  men 
of  science,  where  from  1887  to  1899  he  rendered  efficient 
service  as  our  treasurer  and  served  on  eight  important  com- 
mittees or  as  a  member  of  our  council.  The  life  of  our  fellow 
member  in  fact  needs  less  restatement  from  us  because  since 
he  died  at  least  a  half  dozen  men  of  importance  have  recorded 
their  opinions  of  this  attractive  and  much-loved  man  and  of 
what  he  effected  during  his  ever  busy  existence.  Moreover, 
a  full  and  competent  biography  has  been  undertaken  and  will, 
I  am  sure,  do  ample  justice  to  one  who  owed  nothing  to  news- 
paper notoriety.  Through  his  modest  life  of  the  labor  he 
loved  he  accepted  grave  burdens  and  whatever  duties,  official 
or  other,  fell  to  him,  apparently  indifferent  to  praise  or  popu- 
lar reputation,  while  he  dealt  victoriously  with  tasks  so  various 
in  their  nature  that  any  one  of  them  would  have  sufficed  to 
tax  the  technical  competence  of  the  most  able  man. 

John  Shaw  Billings  was  born  in  Switzerland  County, 
Indiana,  April  12,  1838.  From  the  time  he  went  to  college 
until  after  the  end  of  his  medical  studies  he  was  almost  entirely 

37S 


GA  O/irrQ 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

without  exterior  aid.  He  was  graduated  from  Miami  Uni- 
versity in  1857;  A.  M.  in  i860.  His  personal  struggle  for  a 
college  education  and  the  sacrificial  privations  by  which  he 
attained  his  medical  degree  in  i860  from  the  medical  college 
of  Ohio  will,  I  trust,  be  told  in  full  elsewhere.  He  won  his 
way  unhelped  by  taking  charge  of  the  dissection  rooms  and 
for  one  entire  winter,  as  he  assured  me,  lived  on  seventy-five 
cents  a  week,  as  he  believed  to  the  serious  impairment  of  a 
constitution   of   singular  vigor. 

Hospital  service  gave  him  what  the  imperfect  medical  teach- 
ing of  that  day  did  not  give,  and,  as  demonstrator  of  anatomy, 
he  prepared  himself  for  surgical  practice,  which  was  to  find 
its  opportunities  in  the  clinics  of  the  battlefield. 

In  the  year  1861  came  one  of  the  many  periods  for  decisive 
clioice  he  was  to  encounter  as  life  went  on.  A  certain  career 
as  assistant  to  a  busy  surgeon  was  ofifered  him.  His  strong 
sense  of  duty  to  his  country  made  him  decline  the  tempting 
opportunity  and  he  entered  the  regular  army  first  of  his  class 
in  a  competitive  examination  and  was  commissioned  Assistant 
Surgeon.  U.  S.  A.,  April,  1862. 

To  deal  briefly  with  his  army  career,  he  became  Surgeon- 
Captain  in  1866,  Surgeon-Major  in  1876,  and  Colonel  and 
Deputy  Surgeon-General  in  1890.  He  was  retired  from  active 
service  in  1895  by  President  Cleveland  at  his  own  request  and 
through  the  influence  of  the  University  of  Pennsylvania,  which 
at  this  time  offered  him  the  place  of  professor  of  hygiene. 

During  the  war  he  was  breveted  Major  and  Lieutenant- 
Colonel  for  faithful,  gallant,  and  meritorious  service.  Dr. 
Billings  won  in  the  field  a  high  reputation  as  a  very  skillful 
and  original  operative  surgeon,  and  a  character  for  courage 
and  resourceful  administrative  ability  on  many  occasions,  but 
especially  when  after  the  disastrous  battle  of  Chancellorsville 
he  conducted  the  retreat  of  the  wounded,  and  when  later  he 
was  actively  engaged  in  perilous  service  during  the  battle  of 
Gettysburg. 

During  his  army  service  he  began  very  early  to  exhibit  his 
constructive  talent  in  altering  or  building  hospitals,  and  his 
remarkable  power  of  administrative  command  in  these  vast 
homes  of  the  sick  and  wounded. 

376 


JOHN    SHAW    BILLINGS — MITCHEJLL 

Without  dwelling  too  much  on  this  part  of  his  career,  I  may 
say  that  there  were  many  months  of  service  in  the  field  and 
also  as  an  Acting  Medical  Inspector  of  the  Army  of  the 
Potomac.  Dr.  Billings'  war  service  with  the  army  ended  when, 
in  December,  1864,  he  was  ordered  to  Washington,  where  he 
had  charge  of  the  Invalid  Reserve  Corps,  of  matters  relating 
to  contract  surgeons,  and  a  variety  of  other  business. 

Some  time  in  1864  he  was  sent  by  the  President  with  others 
to  the  West  Indies  on  an  errand  connected  with  the  futile 
plan  for  deporting  some  of  our  recently  made  freedmen  to  an 
island.  This  scheme  appears  to  have  failed,  as  might  have 
been  expected,  and  probably  the  expedition  in  which  he  was 
included  was  meant  to  bring  back  the  men  previously  thus 
deported.  It  was  a  somewhat  fantastic  scheme,  and  I  do  not 
find  any  account  of  it  in  the  histories  of  the  war.  Probably 
Dr.  Billings  had  an  important  share,  for  here,  as  elsewhere,  no 
matter  what  his  relation  was  to  a  body  of  men  and  officers, 
his  peculiar  talents  soon  found  their  influential  place. 

It  becomes  clear  from  what  I  have  already  said  that  his 
capacity  to  turn  with  ease  from  one  task  to  another  must  have 
become  by  this  time  very  well  known  to  his  superiors.  His 
own  desire  was  to  return  to  the  field,  but  the  promise  to  so 
indulge  him  probably  failed  owing  to  the  somewhat  abrupt 
termination  of  the  war.  Meanwhile  he  was  required  to  deal 
with  the  voluminous  medical  reports  sent  in  by  the  medical 
staff  of  the  Army  of  the  Potomac.  The  records  of  this  work 
and  of  his  other  more  individual  surgical  contributions  are 
scattered  through  the  voluminous  medical  and  surgical  history 
of  the  war.  Here,  as  elsewhere,  he  left  in  these  papers  his 
mark  as  a  man  of  many  competencies. 

Some  of  the  duties  to  which  he  was  assigned  before  his 
retirement  were  curiousl)'  outside  of  the  work  of  a  military 
surgeon,  and  he  seems  to  have  been  lent  by  the  War  Depart- 
ment for  a  variety  of  governmental  services.  Thus  while  busy 
with  the  early  work  in  connection  with  the  museum  and 
library,  he  was  also  occupied  with  the  organization  of  the 
United  States  Marine  Hospital  Service  in  1870.  In  1872  he 
was  Vice-President  of  the  brief-lived  National  Bureau  of 
Health,  and  was  for  a  long  period  in  charge  of  the  division 

377 


NATIONAL    ACADKMV    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

of  vital  statistics  of  the  eleventh  census  of  the  United  States. 
During  his  career  as  a  surgeon  in  the  years  before  1895  he 
became  an  authority  on  military  medicine  and  public  hygiene 
and  revived  his  interest  in  hospital  construction,  to  which  he 
had  given  a  great  deal  of  thought.  He  was  one  of  five  who 
submitted  in  1875  by  request  plans  for  the  construction  of  the 
Johns  Hopkins  Hospital.  His  careful  study  of  the  conditions 
required  in  a  hospital  were  accepted.  They  included  many 
things  novel  at  that  time  which  it  is  not  needful  for  me  to 
dwell  upon  here,  but  some  of  them  were  very  original  changes 
from  the  organization  and  construction  to  be  found  in  hos- 
pitals at  that  period. 

During  these  years  he  went  to  Baltimore  from  time  to  time 
and  lectured  on  the  history  of  medicine  and  on  hygiene.  He 
also  supervised  the  planning  and  construction  of  the  Barnes 
Hospital  of  the  Soldiers'  Home,  Washington,  D.  C,  and  later 
the  buildings  needed  for  the  Army  Medical  Museum  and  the 
Surgeon-General's  library.  His  final  constructive  work  late  in 
life  was  his  connection  with  the  plans  for  the  Brigham  Hos- 
pital in  Boston  and  during  many  years  he  was  continually 
consulted  by  institutions  or  cities  in  regard  to  hospitals  and 
hygienic  questions  of  importance. 

The  great  work  of  John  Shaw  Billings  which  gave  him 
finally  a  world-wide  repute  began  at  some  time  after  1864, 
when  he  was  asked  by  the  Surgeon-General  to  take  charge  of 
the  Army  Medical  Museum  created  under  Surgeon-General 
Hammond  by  the  skillful  care  of  Surgeon  John  H.  Brinton. 
His  formal  assignment  "in  charge  of  the  Museum  Library 
Division  and  as  curator  of  the  Army  Medical  ]\Iuseum"  dates 
from  December  28,  1883,  but  he  had  been  informally  librarian 
for  many  years  before  that  time.  It  is  quite  impossible  here 
to  enter  into  any  detailed  account  of  the  ingenuity  and  power 
of  classification  which  has  made  this  museum  the  greatest 
presentation  of  the  effects  of  war  on  the  bodies  of  men.  It  is. 
however,  essential  to  say  a  few  words  about  the  varied  capaci- 
ties which  built  up  and  made  finally  available  to  scholars  the 
library  of  the  Surgeon-General,  now  the  most  completely  use- 
ful collection  of  medical  works  in  the  world. 


378 


JOHN    SHAW    BILUNGS — MITCHELL 

In  some  reminiscences  of  his  younger  days  he  speaks  of  his 
student  aspiration  "to  try  to  estabhsh  for  the  use  of  American 
physicians  a  fairly  complete  library,  and  in  connection  with 
this  to  prepare  a  comprehensive  index  which  should  spare 
medical  teachers  and  writers  the  drudgery  of  consulting  thou- 
sands or  more  indexes  or  the  turning  over  the  leaves  of  many 
volumes  to  find  the  dozen  or  more  references  of  which  they 
might  be  in  search."  The  opportunity  he  craved  when  young- 
came  now  by  singular  good  fortune  into  his  possession.  When 
he  took  hold  of  this  work  the  Surgeon-General's  library  con- 
tained a  little  over  a  thousand  volumes  and  all  interest  in  its 
increase  had  been  long  at  an  end.  Fortunately,  as  I  so  under- 
stand, at  the  close  of  the  war  there  fell  into  the  hands  of  the 
Surgeon-General  some  eighty-five  thousand  dollars,  the  result 
of  hospital  savings  during  the  great  contest.  He  was  allowed 
to  use  this  money  for  the  building  up  of  the  museum  and  of 
the  library,  which  was  an  essential  adjunct  to  the  collection. 
It  was  a  vast  piece  of  good  fortune  that  this  task  fell  to  the 
man  who  had  craved  such  a  chance  since  his  youth.  He 
brought  to  it  powers  which  are  rarely  united  in  one  man  and 
an  amount  of  knowledge  of  books,  medical  and  non-medical, 
which  few  possess.  When  he  was  nominated  for  membership 
in  the  National  Academy  of  Sciences  his  claim  to  this  high 
distinction  was  judiciously  founded  by  his  friends  upon  his 
application  of  skill  in  the  scientific  classification  of  books  and 
of  the  medical  knowledge  of  our  profession  through  the  cen- 
turies. No  medical  librarian  who  ever  lived  had,  up  to  that 
time,  shown  such  an  almost  instinctive  capacity  for  the  scien- 
tific classification  of  knowledge  so  as  to  make  it  readily  avail- 
able. It  was  eminently  a  scientific  gift  and  of  incredible  use- 
fulness in  its  results  to  the  scholarship  of  medicine  throughout 
the  world. 

When  he  gave  up  this  charge  at  the  time  of  his  appointment 
to  the  chair  of  hygiene  in  the  University  of  Pennsylvania,  he 
received  from  the  physicians  of  Great  Britain  and  America  at 
a  dinner  given  in  his  honor  a  silver  box  containing  a  check  for 
ten  thousand  dollars,  as  a  material  expression  of  gratitude  for 
the  labor-savins:  value  of  his  catalogue. 


379 


NATIONAL    ACADEMY    BIOGRAPHICAL    MEMOIRS VOL.  VIII 

The  surplus  of  this  fund  enabled  his  friends  to  present  to 
the  Surgeon-General's  library  an  admirable  portrait  of  John 
Billings  by  Cecelia  Beaux. 

The  library  as  he  left  it  contained  307,455  volumes  and 
pamphlets  and  4,335  portraits  of  physicians.  At  the  present 
day  in  the  skillful  hands  which  took  up  his  task  it  has  reached 
over  half  a  million  volumes  and  over  five  thousand  portraits 
and  has  a  unique  collection  of  medical  journals  quite  matchless 
elsewhere. 

He  went  about  the  preliminary  measures  for  the  catalogue 
with  cautious  care  and  in  1876  prepared  a  specimen  fasciculus 
of  the  proposed  catalogue  of  the  library,  consisting  of  a  com- 
bined index  of  authors  and  subjects  arranged  in  dictionary 
order,  and  submitted  it  to  the  profession  for  criticism.  In 
this  he  was  aided  by  his  able  assistant,  Dr.  Robert  Fletcher. 
In  the  first  series  of  the  index  catalogue,  1880- 1895,  the  mate- 
rial was  selected  and  a  scientific  classification  made  by  Billings. 
The  future  of  the  library  has  been  entirely  in  the  hands  of 
men  at  first  chosen  by  him  and  always  ever  since  by  medical 
officers  of  distinction.  As  a  monthly  supplement  to  the  index 
catalogue,  the  Index  Medicus  was  begun  by  Dr.  Billings  and 
Dr.  Fletcher  in  1879  as  an  extra  official  publication.  When, 
in  1903,  the  second  series  of  the  Index  Medicus  was  started  it 
was  seen  that  there  was  a  risk  of  failure  in  this  invaluable 
publication  through  want  of  means,  but  at  this  time  by  his 
influence  through  the  aid  of  the  Carnegie  Institution  of  Wash- 
ington, it  was  permanently  established  at  the  cost  of  some 
twelve  thousand  dollars  a  year  and  continues  to  be  a  helpful 
aid  to  scholarly  physicians  all  over  the  world. 

It  was  here  that  Dr.  Billings  got  his  training  for  the  still 
larger  task  which  awaited  him  when  he  was  chosen  as  librarian 
of  the  Astor-Tilden-Lenox  Library  in  New  York.  There  at 
once  this  great  enterprise  found  in  him  all  the  varied  qualities 
which  were  needed  in  the  construction  of  the  building,  the 
classification  of  its  contents,  the  efficient  administrative  grasp 
on  the  forty  outlying  libraries  of  New  York  connected  with 
the  triple  library,  and  in  his  singular  power  of  uniting  strict 
discipline  with  a  capacity  to  attach  to  him  those  imder  his 
control. 

380 


JOHN    SHAW    BILLINGS — MITCIIICLL 

Throughout  his  life  he  was  a  busy  writer  of  essays  on 
hygiene,  hospital  construction,  and  administration,  the  statistics 
of  war  and  addresses  or  essays  such  as  his  history  of  surgery, 
perhaps  the  best  presentation  of  this  subject  ever  made. 

To  comprehend  the  character  of  a  man,  he  must  have  been 
seen  in  his  relation  to  the  various  duties  which  test  the  quali- 
ties of  both  heart  and  head.  The  charge  of  suffering,  crippled, 
wounded  soldiers  is  a  trial  to  the  surgeon  and  here  he  showed 
the  man  at  his  best.  He  was  patient  with  the  impatient,  never 
irritable  with  the  unreason  of  sufferers,  never  seeming  to  be  in 
a  hurry,  and  left  at  every  bedside  in  the  long,  sad  wards  the 
impression  of  being  in  earnest  and  honestly  interested. 

It  was  thus  I  first  knew  John  Billings  when  in  the  crowded 
wards  wearied,  homesick  men  welcomed  his  kindly  face  and 
the  almost  womanly  tenderness  he  brought  to  a  difficult  service. 

My  own  personal  relations  with  John  Billings  began  eariy 
in  the  Civil  War,  when  he  had  for  a  long  time  the  care  of  my 
brother,  a  medical  cadet,  during  a  mortal  illness  contracted  in 
the  Douglas  Hospital,  Washington.  I  saw  then  how  gentle- 
minded  was  this  man  and  how  he  realized  the  pathetic  disap- 
pointment of  a  highly  gifted  young  life  consciously  drifting 
deathward.  I  saw  thus  a  side  of  John  Billings  he  rarely 
revealed  in  its  fullness.  Generally  a  rather  silent  man,  he  was 
capable  now  and  then  of  expressing  in  eloquent  brevities  of 
speech  the  warmth  of  his  regard  for  some  one  of  the  few  lie 
honored  with  his  friendship.  In  the  last  talk  I  had  with  him 
he  said  to  me  some  things  which  remain  as  remembrances  of 
this  rather  taciturn  and  reserved  gentleman.  I  had  asked  him 
how  many  degrees  and  like  honors  he  had  received  and,  con- 
sidering these  notable  recognitions,  I  remarked  on  the  failure 
of  popular  appreciation.  He  replied  with  a  jesting  comment 
and  then  said,  after  a  brief  silence,  that  he  was  far  more  proud 
of  his  capacity  to  win  the  friendship  of  certain  men  and  of  the 
service  he  had  been  able  to  render  to  science  in  his  connection 
with  the  Carnegie  Institution  of  Washington.  There,  indeed, 
his  always  wise  and  broad-minded  interest  will  be  greatl\' 
missed.  I  served  with  him  from  its  foundation  on  the  distin- 
guished executive  committee  of  this  body.  Here,  among  men 
he  liked  and  trusted,  we  saw  him  at  his  familiar  best.     Always 

381 


NATIONAL    ACADEMY    BIOGRAPHICAL    MEMOIRS VOL.  VIII 

a  patient  listener,  his  decisions  as  chairman  were  expressed 
with  his  quiet,  courteous  manner,  and  many  times  his  large 
knowledge  of  the  science  of  the  day  left  me  wondering  ho\v 
it  could  have  been  attained  amid  the  amazing  number  of  occu- 
pations which  had  filled  his  time.  But  in  fact  he  was  intellect- 
ually sympathetic  with  every  form  of  scientific  research — a 
somewhat  rare  characteristic  among  investigators.  I  ought 
also  to  say  that  the  men  of  our  committee  and  of  the  board 
of  trustees  felt  at  times  a  little  surprise  at  the  shrewdness,  the 
common  sense,  and  the  commercial  insight  he  brought  to  the 
critical  financial  consideration  of  this  immense  money  trust. 
Not  elsewhere  was  he  better  seen  or  understood  as  conveying 
the  sense  of  character,  and  nowhere  else  was  he  better  loved. 

Numberless  presidencies  of  societies  fell  to  his  share,  and 
the  list  of  his  honorary  titles  from  all  of  the  greater  academies 
and  universities  at  home  and  abroad  served  at  least  to  show  in 
what  esteem  he  was  held  by  men  of  science.  These  recogni- 
tions gave,  I  suspect,  more  pleasure  to  his  friends  than  to  this 
retiring  and  singularly  unambitious  scholar. 

On  public  occasions  his  personality  stood  for  something  in 
the  estimate  of  the  man.  Tall  and  largely  built,  he  was  as  a 
speaker  in  the  after-dinner  hour  or  when  addressing  a  body 
of  men  a  commanding  presence,  with  flow  of  wholesome 
English,  ready  wit  and  humor  such  as  rarely  came  to  the  sur- 
face in  his  ordinary  talk.  The  figure  of  athletic  build,  the 
large  blue  eyes,  a  certain  happy  sense  of  easy  competence,  won 
regard  and  held  the  respectful  attention  of  those  who  listened. 
For  me  there  was  always  some  faintly  felt  sense  of  that  expres- 
sion of  melancholy  seen  often  in  men  who  carry  through  a 
life  of  triumphant  success  the  traces  of  too  terrible  battle  with 
the  early  difficulties  of  their  younger  days. 

What  was  most  exceptional  in  this  man  was  the  unfailing 
fund  of  energy  on  which  he  drew  for  every  novel  duty,  and 
an  industry  which  never  seemed  to  need  the  refreshment  of 
idleness.  He  had  that  rare  gift — the  industry  of  the  minute. 
When  once  I  spoke  of  the  need  for  leisurely  play  and  the  exer- 
cise of  open-air  sports,  he  said  that  he  obtained  recreation  by 
turning  from  one  form  of  brain  use  to  another.  That  was 
play  enough.     I  ought  to  add  that  he  found  pleasure  in  read- 

382 


JOHN    SHAW    BILLINCS — MITCH  KLL 

ing  novels,  saying  that  one  or  two  of  an  evening  late  were 
agreeable  soporifics.  But  these,  like  more  serious  books,  lie 
devoured  rather  than  read  as  most  men  read,  and  what  he  read 
he  seemed  never  to  forget.  His  memory  was  like  a  good 
index  of  a  vast  mental  library. 

Until  his  later  years  Dr.  Billings  possessed  the  constitutional 
vigor  which  befriended  him  earlier  as  he  responded  to  the 
call  of  a  succession  of  military  and  civic  duties.  Of  late  years 
he  was  obliged  to  undergo  several  surgical  operations  of  seri- 
ous nature.  He  went  to  them  with  confidence  and  courage, 
but  before  the  last  one  he  said  to  me,  "I  am  for  the  first  time 
apprehensive."  He  went  on  to  add,  "It  is  a  signal  of  age ;  and 
of  late,  as  never  before,  any  new  project,  any  need  for  change 
in  the  affairs  of  the  library,  I  find  arouses  in  me  an  unreason- 
able mood  of  opposition.  This,  too,  is,  I  know,  a  sure  evi- 
dence of  my  being  too  old  for  my  work.  I  shall,  I  think, 
resign  my  directorship  of  the  library."  It  was  our  last  inti- 
mate talk.  He  died  of  pneumonia  after  the  operation,  on  the 
eleventh  of  March,  1913. 

The  scene  at  his  burial  in  the  military  cemetery  at  Arlington 
brought  together  many  men  of  distinction,  a  much  moved 
group  of  army  men  and  the  great  library  officials.  We  left  in 
the  soldier  burial  ground  all  that  was  mortal  of  a  man  who 
combined  qualities  of  head  and  heart  such  as  none  of  us  will 
see  again. 

Dr.  Billings  married  Miss  Kate  M.  Stevens  in  September, 
1862.  Their  children  are:  Mary  Clure,  Kate  Sherman,  Jessie 
Ingram,  John  Sedgwick,  and  Margaret  Janeway. 

Science  is  forever  changing.  The  work  of  today  is  contra- 
dicted tomorrow.  Few,  indeed,  are  so  fortunate  as  to  leave  in 
the  permanent  remembrance  of  science  conclusive  work.  The 
man  whose  loss  we  regret  left  to  medicine  in  his  catalogue  of 
the  Surgeon-General's  Library  a  monumental  labor  which  none 
will  ever  better  and  to  whicli  he  gave  continuity  of  vigorous 
life. 


3^3 


THE  SCIENTIFIC  WORK  OF  DR.  JOHN  SHAW 
BILLINGS 

I5Y  FIELDING  H.  GARRISON,   M.  D. 


John  Shaw  Billings,  perhaps  the  most  versatile  American 
physician  of  his  time,  achieved  excellence  and  gained  distinc- 
tion in  no  less  than  six  different  fields — in  military  and  public 
hygiene,  in  hospital  construction  and  sanitary  engineering,  in 
vital  and  medical  statistics,  in  medical  bibliography  and  history, 
in  the  advancement  of  medical  education  and  the  condition  of 
medicine  in  the  United  States,  and  as  a  civil  administrator  of 
unique  abilities. 

Shortly  after  receiving  his  medical  degree  from  the  Medical 
College  of  Ohio  (i860).  Dr.  Billings  prepared  to  enter  upon 
surgical  practice  in  Cincinnati,  w^here  his  prospects  were  excel- 
lent, but  the  outbreak  of  the  Civil  War  turned  his  mind  to  the 
larger  service  of  his  country,  and,  in  September,  1861,  he 
passed  his  examination  before  the  examining  board  for  admis- 
sion to  the  Medical  Corps  of  the  United  States  Army  and  was 
duly  commissioned  First  Lieutenant  and  Assistant  Surgeon 
on  April  16,  1862.  As  an  army  surgeon  his  services  were  con- 
tinuous and  included  some  twenty-one  months'  work  in  hos- 
pital and  a  full  year  of  roughing  it  in  the  field.  He  long  after- 
wards described  this  experience  as  his  postgraduate  course  in 
surgery,  "with  its  service  in  camps  and  hospitals,  with  battle- 
fields for  the  great  clinics — a  long,  weary  course."  During 
the  Civil  War  his  reputation  for  courage  and  ability  was  of 
the  best,  and  the  end  of  the  great  struggle  found  him  one  of 
the  medical  inspectors  of  the  Army  of  the  Potomac,  with  a 
brevet  of  Lieutenant-Colonel  "for  faithful  and  meritorious 
services"  (1865).  Being  in  charge  of  Cliffburne  Hospital, 
near  Georgetown.  July  3,  1862,  assisted  by  fifteen  Sisters  of 
Charity,  he  took  care  of  many  Union  and  Confederate  wounded 
from  the  seven  days  before  Richmond,  and  did  nearly  all  of 
the  operating.  At  Chancellorsville,  he  and  his  assistants  worked 
night  and  day,  under  artillery  fire,  in  feeding  and  taking  care 

38s 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

of  the  wounded ;  at  Gettysburg,  his  experiences  were  the  same, 
and  in  both  battles  he  did  an  enormous  amount  of  surgical 
work.  During-  the  war  he  performed  nearly  all  the  major 
operations  done  in  the  pre-Listerian  period,  and  he  was  the 
first  surgeon  in  the  war  to  attempt  the  rare  operation  of  ex- 
cision of  the  ankle  joint  (January  6,  1862),  which  had  been 
done  only  two  or  three  times  before  in  the  history  of  surgery, 
and  was  completely  successful  in  his  case.  Lister's  classical 
paper  on  excision  of  the  wrist,  a  landmark  in  the  surgery  of 
the  joints,  was  not  published  until  1865. 

On  August  22,  1864,  having  been  disabled  during  the  long 
siege  of  Petersburg,  he  was  relieved  from  duty  in  the  field 
and  assigned  to  the  Washington  office  of  the  Medical  Director 
of  the  Army  of  the  Potomac,  where  he  assisted  in  the  redac- 
tion of  the  field  reports,  which  were  subsequently  embodied  in 
the  Medical  and  Surgical  History  of  the  War.  On  December 
27,  1864,  he  was  transferred  to  the  Surgeon-General's  Office  of 
the  War  Department,  where  he  was  to  remain  for  thirty  years, 
up  to  the  date  of  his  retirement  from  active  service  in  the 
army,  October  i,  1895.  Here  his  real  life  work  began.  Prior 
to  this  period  his  only  contribution  to  scientific  literature  was 
a  graduating  dissertation  on  epilepsy,  already  notable  for  clear- 
headed common  sense  and  a  certain  quaint  vein  of  humor. 
His  most  important  contributions  to  medical  science  were  made 
during  the  thirty  years  of  his  incumbency  as  librarian  of  the 
Surgeon-General's  Office. 

Upon  assuming  his  new  duties  at  the  beginning  of  1865, 
Billings  threw  himself  into  the  dry  details  of  departmental 
routine  in  his  cool,  imperturbable  way,  and  during  the  next 
five  years  he  was  principally  occupied  with  the  official  drudg- 
ery connected  with  the  business  of  disbanding  the  great  body 
of  acting  assistant  surgeons  of  the  war,  dismantling  the  mili- 
tary hospitals,  and  winding  up  the  financial  accounts  of  both. 
In  this  period  he  read  assiduously,  wisely,  and  well,  and  applied 
himself  with  zest  to  microscopic  work,  which  was  then  coming 
into  fashion  in  this  country.  After  casting  about  in  various 
directions,  he  settled  down  to  the  investigation  of  the  minute 
fungi,  of  which  he  published  two  studies  in  the  American 
Naturalist  in   1871,  and  at  the  same  time  made  a  valuable 

386 


JOHN    SHAW    RH^LINGS — MITCHELL 

private  collection,  which  he  long  after  presented  to  the  New 
York  Botanical  Garden  in  1902.  Meanwhile,  in  1869.  he  had 
collaborated  with  his  army  colleague,  Dr.  Edward  Curtis,  in 
a  special  report  on  the  possible  cryptogamic  origin  of  the 
Texas  fever  and  pleuropneumonia  of  cattle.  The  object  of 
this  research  was  to  ascertain  if  the  so-called  cryptogamous 
diseases  of  cattle  were  caused  by  the  "micrococcus  of  Hallier." 
The  findings  were  negative  and  the  investigation  is  null  today. 
Significant,  however,  is  the  prophetic  statement  that,  in  estab- 
lishing a  causal  relation,  the  lancet  and  injection  tube  would 
probably  accomplish  more  than  the  microscope  and  culture 
apparatus. 

About  this  time  Dr.  Billings  entered  upon  his  career  in  pub- 
lic and  military  hygiene.  During  i86r)-'74  he  was  detailed, 
under  the  Secretary  of  the  Treasury,  to  inspect  and  report 
upon  the  status  of  the  Marine  Hospital  Service,  which  was 
then  sadly  in  arrears  on  account  of  the  poor  administration 
incident  to  bad  political  appointments.  In  this  relation,  Billings 
traveled  over  the  length  and  breadth  of  the  country.  His 
recommendations,  based  upon  what  he  saw  during  his  tours 
of  inspection,  were  adopted  and  the  value  of  his  services 
acknowledged  by  the  Secretary  of  the  Treasury  as  follows : 
"The  condition  of  the  marine  hospitals  has  been  improved  dur- 
ing the  past  year.  This  result  is  largely  due  to  Dr.  J.  S.  Bil- 
lings, of  the  Surgeon-General's  Office,  who  has  visited  nearly 
all  of  them,  and  through  whose  advice  many  important  changes 
have  been  made."  ^  The  principal  thing  he  did  for  the  service 
was  to  take  it  out  of  politics  and  give  to  it  the  military  methods 
of  organization.  Known  as  the  Public  Health  Service  since 
1912,  this  branch  of  the  Government  now  works  hand  in  hand 
with  the  medical  establishments  of  the  Army  and  Navy  in  the 
advancement, of  preventive  medicine. 

In  1870  and  1875,  ^^-  Billings  made  two  reports  to  the 
Surgeon-General  upon  barracks  and  hospitals  and  upon  the 
hygiene  of  the  United  States  Army.  These  became  classical, 
at  least  as  far  as  our  own  military  establishment  is  concerned. 
In  the  first  monograph,  now  known  as  Circular  4,  he  collated 


*Rep.  Sec.  Treasury,  Washington,  1870,  p.  xii. 

387 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

and  edited  some  527  pages  of  reports  from  medical  officers  on 
the  barracks  and  hospitals  of  "the  best  fed  and  worst  housed 
army  in  the  world."  His  criticism  of  these  hospitals  is  drastic 
and  was  the  basis  of  his  future  work  as  a  hospital  constructor. 
He  describes  the  pictures  of  U.  S.  Army  hospitals  in  the 
report  as  "simply  inserted  as  ingenious  modes  of  'how  not  to 
do  it'  " ;  but  he  recognizes  that,  in  a  country  of  such  wide 
extent  as  ours,  hospital  plans  must  suit  the  climatic  exigencies 
of  "the  burning  mesas  of  Arizona  and  the  bleak  north  Atlantic 
coast."  His  main  contention  throughout  is  against  the  false 
economy  which  results  in  "a  saving  in  boards  and  brick  at  the 
expense  of  the  health  of  the  soldier."  Circular  No.  8,  Dr. 
Billings's  report  upon  the  hygiene  of  the  United  States  Army, 
is,  in  effect,  a  strong  brief  in  aid  of  improving  the  health  and 
personal  well-being  of  the  enlisted  man.  Bath  tubs  and  shower 
baths,  abundant  space  and  good  ventilation  in  quarters,  a  ration 
at  least  twenty-five  per  cent  in  excess  of  what  is  required, 
plenty  of  ice  at  Southern  posts,  lime  juice  and  baking  powder 
for  scouts,  canned  tomatoes  where  fresh  vegetables  are  not 
available,  are  recommended  as  novelties ;  and  it  is  especially 
urged  that  the  chief  cook  at  a  post  should  be  a  permanent 
detail,  in  place  of  the  then  custom  of  changing  company  cooks 
every  ten  days ;  that  schools  for  instruction  of  cooks  should 
be  established  at  recruiting  stations  and  a  manual  of  cookery, 
with  dietetic  tables  and  culinary  directions  for  all  climates  and 
seasons,  prepared.  The  report  concludes  with  timely  observa- 
tions on  the  ventilation,  hygiene  and  avoidance  of  infection  in 
the  military  hospitals.  As  part  of  Billings's  work  in  military 
medicine  should  be  mentioned  his  "Notes  on  Military  Medicine 
in  Europe"  (1882),  his  report  to  the  International  Medical 
Congress  at  Berlin  on  international  uniformity  in  medico- 
military  statistics  (1890),  and  his  address  on  "The  Military 
Medical  Officer  at  the  Opening  of  the  Twentieth  Century" 
(1903).  Shortly  before  his  retirement  from  the  army.  Dr. 
Billings  became  professor  of  military  hygiene  in  the  newly 
established  Army  Medical  School  at  Washington  (1894). 

About  1874,  Dr.  Billings  began  to  be  active  in  the  affairs 
of  the  American  Public  Health  Association,  of  which  he  was 
made  president  in  1880.     To  its  annual  reports  he  contributed 

388 


JOHN    SHAW    BILIvINGS GARRISON 

papers  on  the  effect  of  mountain  climate  upon  liealtli  (  1874 J, 
on  hospital  construction  (1874),  on  medical  topography 
(1875),  on  a  plan  for  a  systematic  sanitary  survey  of  the 
United  States  (1875),  o"  community  rights,  duties,  and  privi- 
leges in  relation  to  public  health  (1876),  on  a  sanitary  survey 
of  Memphis,  Tennessee  (1879),  and  others.  These  titles  all 
connote  pioneer  hygienic  work  of  the  most  advanced  type,  for 
it  must  be  remembered  that  there  were  no  uniform  quarantine 
regulations  in  the  United  States  before  1893,  and  that  before 
1901  only  ten  States  of  the  Union  had  even  a  satisfactory 
system  of  vital  statistics.  The  truth  is  that  until  recent  times 
the  advancement  of  public  hygiene  in  all  countries  and  at  all 
periods  of  the  world's  history  has  been  fitful  and  capricious, 
always  lagging  behind  the  general  trend  of  progress  and  usu- 
ally following  in  the  wake  of  some  devastating  epidemic  dis- 
ease. The  despised  Middle  Ages,  for  instance,  had  a  reallv 
impressive  array  of  municipal  laws  and  ordinances,  hastily 
improvised  against  the  scourges  of  pandemic  leprosy,  bubonic 
plague,  and  syphilis,  as  we  have  only  just  begun  to  learn 
through  the  extensive  historical  researches  of  Haeser  and  Sud- 
hoff.  Modern  Europe  was  awakened  to  an  interest  in  pre- 
ventive medicine  through  the  great  cholera  epidemic  of  1830 
and  the  three  visitations  of  the  same  disease  which  followed 
successively  upon  each  other  during  the  decades  i840-'70.  The 
splendid  system  of  sanitary  legislation  of  England,  the  best 
and  most  progressive  in  the  modern  world,  started  with  the 
cholera  epidemic  of  i840-'5o,  which  also  occasioned  the  first 
sanitary  survey  in  America — that  of  the  State  of  Massachu- 
setts in  1849.  I"  Billing's  time  the  immediate  incentives  to 
progress  ip  sanitation  were  the  yellow  fever  epidemics  of  1878 
and  1879.  These  occasioned,  among  other  things,  the  founda- 
tion of  the  short-lived  National  Board  of  Health  (March  3, 
1879),  an  attempt  at  a  Federal  organization  of  which  Dr. 
Billings  was  appointed  vice-president  at  the  start,  and  which 
died  out  through  lack  of  congressional  appropriations  in  1886. 
Its  powers  had  been  enlarged  by  the  National  Quarantine  Act 
of  1879;  its  personnel  included  some  of  the  best  men  of  the 
time,  its  transactions  give  abundant  evidence  of  good  and  ardu- 
ous work,  but   such   an   infantile   organization,   described  by 

389 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

Billings  himself  as  "a  premature  birth,"  could  not  survive  the 
inevitable  struggles  with  the  State  authorities  as  to  local  quar- 
antine, and  its  place  has  been  very  adequately  taken  by  the 
present  U.  S.  Public  Health  Service.  The  scientific  work  of 
the  National  Board  of  Health  included  the  investigation  of 
yellow  fever  in  Cuba  by  Sternberg,  Guiteras,  Chaille  and 
Hardie,  Professor  Ira  Remsen's  investigation  of  organic  mat- 
ter in  the  air,  the  sanitary  surveys  of  New  York  harbor  and 
Memphis,  Tennessee,  and  Billings's  reports  on  nosology,  the 
proper  nomenclature  of  diseases  in  relation  to  the  registration 
of  vital  and  medical  statistics.  This  matter,  which  was  the 
starting  point  of  Billings's  remarkable  labors  on  the  United 
States  census,  as  also  of  his  classification  of  diseases  in  the 
Index  Catalogue  and  Index  Medicus,  occupied  his  time  and 
attention  for  many  years.  It  was  one  of  his  main  ambitions 
to  establish  a  definite  system  for  the  registration  of  deaths  and 
diseases  in  this  country  and  to  have  it  standardized  in  the  sev- 
eral States,  because  he  saw  clearly  that  this  would  be  the  first 
step  towards  standardizing  the  status  of  physicians  who  might 
presume  to  make  certificates  as  to  the  cause  of  death  and  the 
nature  of  the  disease  in  each  case.  At  the  International  Med- 
ical Congress  at  London  in  1881,  and  again  at  the  annual  meet- 
ing of  the  British  Medical  Association  at  Brighton  in  1886,  he 
spoke  in  a  very  definite  and  decided  way  of  this  crying  defi- 
ciency in  our  national  medical  legislation.  In  1881,  the  criteria 
for  determining  the  ethical,  professional,  and  scientific  status 
of  (sometimes  self-styled)  "physicians"  were  established  in 
Illinois  by  the  State  Board  of  Health,  and  in  Alabama  by  the 
State  Medical  Society,  which  also  officiated  as  the  State  Board 
of  Health.  In  relation  to  the  subsequent  advances  which  have 
been  made  by  the  American  Medical  Association  and  other 
bodies  in  elevating  the  status  of  physicians,  of  the  medical 
schools  which  educate  these  physicians,  and  of  the  medical 
periodicals  which  are  their  organs  of  opinion,  the  early  propa- 
gandism  of  Billings  sould  be  remembered.  In  his  own  day  he 
was  as  one  crying  in  the  wilderness,  for  the  tendency  of  the 
medical  politicians  of  the  time  was  not  to  level  upward  to  a 
higlier  standard,  but  inevitably  downward. 

Another  project  which  Billings  had  very  much  at  heart  was 

390 


JOHN  Shaw  billings — garrison 

the  possibility  of  making  a  searching  sanitary  survey  of  the 
whole  United  States  as  the  first  step  towards  establishing  a 
perfect  system  of  sanitation  in  its  ditYerent  cities  and  com- 
munities, according  to  their  special  needs.  This  idea,  to  diag- 
nose or  blue-print  the  diseases  of  a  comnumity  or  country 
before  attempting  to  treat  or  prevent  them,  originated  with 
Hippocrates,  the  Father  of  Medicine,  who,  in  his  excursus 
"On  Airs,  Waters,  and  Places,"  was  the  creator  of  medical 
topography.  In  his  "Remarks  on  Medical  Topography,"  read 
before  the  American  Public  Health  Association  in  1875,  Bil- 
lings gives  a  history  of  the  subject  in  this  country.  In  1672, 
the  Welsh  physician,  Charles  Clermont,  had  essayed  a  medical 
topography  of  England  along  the  old  liippocratic  lines.  The 
first  treatise  of  this  kind  relating  to  the  United  States  was 
Lionel  Chalmers'  "An  Account  of  the  Weather  and  Diseases 
of  South  Carolina"  (London,  1776)  ;  but  the  real  pioneer  of 
medical  topography  in  America  was  the  celebrated  Daniel 
Drake,  in  his  "Picture  of  Cincinnati  and  the  Miami  Country" 
(1813),  which  was  the  foundation  of  his  great  work  "On  the 
Principal  Diseases  of  the  Interior  Valley  of  North  America" 
(i85o-'54).  In  this  vast  treatise,  now  a  classic,  Drake  trian- 
gulates the  whole  Mississippi  Valley  as  to  topography,  climate, 
meteorology,  natural  history,  population,  and  diseases.  In 
1843,  the  medical  section  of  the  National  Institute  at  Wash- 
ington had  prepared  and  circulated  a  schedule  of  inquiries  in 
aid  of  collecting  data  of  this  kind,  but  the  committeemen,  sent 
from  this  body  to  the  American  Medical  Association  upon  its 
foundation  in  1847,  reported  failure  in  their  efforts  for  the 
following  significant  reasons : 

"First,  the  general  apathy  existing  even  in  the  minds  of  medical 
men  on  the  subject  of  hygiene;  and,  second,  the  favorable  opinions 
entertained  by  almost  every  one  addressed  by  the  committee  of  the 
healthfulness  of  his  own  locality.  *  *  *  The  United  States  may  he 
considered  as  a  country  in  which  no  legislative  enactments  exist  regu- 
lating its  sanitary  condition.  For,  with  the  exception  of  some  munic- 
ipal regulations  forced  from  the  necessity  of  circumstances  upon  the 
large  cities,  and  a  few  of  the  first  steps  of  legislation  in  one  or  two  of 
the  States,  each  individual  is  permitted  to  exercise  his  own  free  will 
in  regard  to  hygienic  measures,  too  frequently  at  the  expense  of  great 
sacrifices  of  human  life."" 


'Repts.  and  papers  Amer.  Publ.  Health  Assoc,  i874-'5,  N.  Y.,  1876, 
ii,  41. 

391 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

In  1848,  the  Committee  on  Public  Hygiene  of  the  American 
Medical  Association  drew  up  a  schedule  of  questions  similar 
to  the  above  and  some  interesting  papers,  by  way  of  reply, 
were  obtained  from  the  larger  cities  of  the  country.     Some  of 
the  State  medical  societies,  particularly  that  of  Pennsylvania, 
in   1855  also  undertook  to  collect   medico-topographical   data 
through   the  county  medical   societies.     But,   as    Billings   re- 
marked, it  needed  "but  a  brief  examination  of  these  records 
to  prove  that  a  comprehensive  sanitary  survey  of  a  State  will 
probably  never  be  accomplished  by  a  State  medical  society." 
"The  most  valuable  contributions  to  medical  topography  in 
this  country,"  he  adds,  "so  far  as  regards  completeness  and  as 
affording  data  for  a  science  of  the  etiology  of  disease,  are  the 
reports  made  by  the  medical  officers  of  the  army  descriptive 
of  their  several  posts.     *     *     *     This  is  due  to  the  fact  that 
these  reports  give  the  statistics  of  disease  and  the  meteorology 
of  each  post  upon  a  uniform  plan,  and  thus  afford  the  means 
of  comparison  between  different  localities."     Upon  such  a  plan 
Billings,  as  chairman  of  the  Committee  on  a  Sanitary  Survey 
of  the  United  States   (American  Public  Health  Association, 
1875),  caused  his  experts  to  draw  up  a  questionnaire,  compris- 
ing upwards  of  four  hundred  searching  queries  bearing  upon 
the   geographical    locale,    climate,    population,    water    supply, 
drainage,   habitations,   schools,   hospitals,   and  prisons,   ceme- 
teries, public  health  and  quarantine  regulations,  diseases  and 
other  features  of  a  given  community ;  and  these  were  to  be 
submitted  to  some  325  American   cities  and  towns  of  5,000 
inhabitants  or  more.     This  plan,  which  Billings  regarded  as 
sufficient   to   establish  "the   foundations   of   a   national   public 
hygiene  in  this  country,"  as  setting  in  motion  the  machinery 
for  a  perfect  system  of  sanitation,  was  tried  out  in  two  or 
three  cities,  but  it  was  found  that,  b)-  reason  of  the  large  num- 
ber of  leading  questions  and  the  difficulty  of  getting  physicians 
to  answer  them,  not  to  mention  tlie  expensive  alternative  of 
employing  experts   for   this   purpose,   the   project   had   to  be 
abandoned,   as  in  the  initial   attempt   made   in    i845-'7.     The 
sentences  in  which  Billings  urges  this  project  upon  physicians 
and  legislators  are  pregnant  with  meaning,  expressive  of  his 
strong  character  and  of  the  spirit  in  which  his  incisive  mind 

392 


h 


JOHN    SHAW    BHJ.INr,S GARRISON 

was  to  apply  itself  in  its  future  grapplings  with  the  dehciencics 
of  the  United  States  census. 

"It  has  been  an  article  of  professional  as  well  as  popular  belief  since 
the  da3S  of  Hippocrates  that  the  study  of  prevailing  diseases  of  differ- 
ent places,  with  reference  to  their  local  causes,  is  of  great  value,  and 
that  all  work  in  this  direction  should  be  encouraged  as  much  as  pos- 
sible. Many  books  and  essays  have  been  printed  under  the  title  uf 
Medical  Topography;  and,  to  judge  from  the  bibliography  of  the  sub- 
ject only,  we  might  fairly  suppose  that  a  large  amount  of  data— scat- 
tered and  disconnected,  it  is  true — has  been  obtained  and  recorded. 
But  when  we  come  to  examine  these  papers  in  detail  it  will  be  found 
in  most  cases  that,  while  topographical  data  are  given,  the  medical  part 
has  been  left  out ;  that  the  majority  of  them  refer  to  but  one  form 
of  disease — the  malarial — and  to  the  conditions  which  affect  its  preva- 
lence, and  that  the  information  in  regard  to  this  is  vague  and  general. 
Even  the  most  complete  and  satisfactory  essays,  with  the  exception 
of  the  army  reports,  rely  upon  mortality  statistics  alone ;  and  these,  no 
matter  how  complete,  \vill  not  furnish  the  information  necessary  for  a 
satisfactory  investigation  into  the  causes  of  disease,  which  is  the  one 
great  object  of  medical  topography.  We  want  to  know  how  many  of  a 
given  populations  have  been  sick,  of  what  disease,  and  for  how  long. 
For  this  purpose  the  statistics  of  all  diseases  are  not  of  equal  im- 
portance, for  we  can  expect  no  special  advantage  from  knowing  how 
many  cases  of  venereal  or  delirium  tremens  occur  in  a  given  square ; 
but  we  must,  of  course,  record  many  facts  for  the  same  reason  that 
the  pearl-diver  collects  many  oysters — because  we  do  not  know  whether 
they  are  valuable  or  not.  For  instance,  most  persons  would  say  that 
topography  has  no  relation  to  cancer,  and  yet  there  are  some  curious 
coincidences  with  regard  to  its  prevalence  in  limited  localities.  *  *  * 
These  statistics  can,  of  course,  be  obtained  only  by  the  aid  of  physi- 
cians ;  but  to  induce  physicians  to  undertake  such  a  task  as  this  some 
sufficient  motive  must  be  presented. 

"It  must  be  remembered  that  the  art,  or  the  so-called  practical  part 
of  public  hygiene,  does  not  specially  pertain  to  the  medical  profession. 
Medical  men  have  been  foremost  in  urging  attention  to  the  prevention 
of  disease,  both  on  the  part  of  individuals  and  the  public,  not  because 
it  is  specially  to  their  interest  to  do  so,  but  because  their  sympathies 
are  daily  and  hourly  appealed  to  by  the  spectacle  of  human  suffering 
which  they  know  might  have  been  prevented,  but  which  they  find 
difficult  or  impossible  to  relieve. 

"Medical  men  see  more  or  less  distinctly  that  a  properly  organized 
system  of  State  medicine  or  public  hygiene  would  require  from  each  of 
them  a  certain — and  from  many  a  considerable — amount  of  labor  in 
keeping  records  and  furnishing  information,  while  no  corresponding 
recompense  is  proposed.  They  are  naturally  unwilling  to  furnish  in- 
formation to  and  co-operate  with  persons  in  whose  selection   for  the 

393 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

position  of  health  officer  they  have  had  no  voice,  and  for  whom  they 
often  have  little  respect ;  and  this  will  continue  so  long  as  the  medical 
profession  is  not  consulted  in  the  selection  of  State  and  municipal  sani- 
tary authorities.  To  undertake  to  ascertain  for  a  large  city  the  num- 
ber of  cases  and  the  results  of  each  form  of  disease  is  practically 
impossible.  It  is  hard  enough  to  obtain  the  statistics  of  causes  of 
death  with  any  reasonable  degree  of  accuracy,  since  physicians,  like 
other  people,  are  not  addicted  to  doing  steady  work  without  some  com- 
pensation; but  if,  instead  of  all  diseases,  we  devote  our  attention  to  a 
few,  the  prospect  is  not  so  hopeless.     *     *     * 

"By  the  comparison  and  study  of  the  daily  bulletin  maps  of  the 
Signal  Bureau  we  have  learned  somewhat  of  the  paths,  rate  of  travel, 
and  phenomena  of  the  air-whirlpools,  and  it  is  not  impossible  that  we 
may  yet,  in  like  manner  and  by  somewhat  similar  means,  become 
acquainted  with  the  course  of  certain  diseases,  and,  if  not  able  to  pre- 
vent, can  at  least  warn  and  avoid.     *     *     * 

"A  satisfactory  medical  topography  should  have  reference  not  only 
to  the  causation,  but  to  the  prevention  and  cure  of  disease.  Change  of 
locality,  as  a  therapeutic  agent,  is  coming  more  and  more  into  use, 
especially  as  regards  diseases  of  the  lungs,  rheumatism,  etc.;  but  as 
yet  physicians  have  no  sufficient  data  to  guide  them  in  recommending 
given  localities  to  their  patients.     *     *     * 

"We  must  endeavor  to  ascertain  what  the  French  call  'the  medical 
constitution  of  a  place,'  the  results  of  epidemic  influences  which  arc 
not  yet  epidemics,  and  the  modifications  which  these  undergo  in  differ- 
ent localities.     *    *    * 

"In  medical  topography  as  a  science  there  has  been  little  advance 
for  a  thousand  years,  and  so  long  as  the  present  methods  are  pursued 
no  great  additions  to  our  knowledge  in  this  direction  can  be  expected. 
Vague  generalities  and  opinions  must  be  replaced  by  specific  informa- 
tion, and  from  square  miles  we  must  come  down  to  square  feet.  The 
results  which  we  now  have  can  best  be  compared  to  those  obtained  by 
the  young  chemist  who  made  an  analysis  of  a  rat — putting  the  entire 
animal  into  his  crucible.  The  importance  to  a  State  or  government  of 
a  complete  topographical  survey  of  its  possessions  has  long  been  rec- 
ognized ;  and  much  as  has  been  done  in  this  direction,  it  is  now  urged, 
by  those  most  familiar  with  the  subject,  that  in  all  of  the  States  of  this 
country  a  careful  survey,  with  the  preparation  of  maps  on  a  large 
scale,  similar  to  the  work  which  has  been  done  in  England  and  Switzer- 
land is  necessary,  and  must  sooner  or  later  be  effected.  And  it  can 
hardly  be  doubted  that  in  such  surveys  the  prevailing  diseases  of  each 
locality  should  be  recorded  as  carefully  as  its  geolog3^  botany,  or 
zoolog>\" ' 

The  address  which  Billings  delivered  as  president  of  the 
American  Public  Health  Association  at  New  Orleans  (Decem- 

^Ibid.,pp.  so-53- 

394 


JOHN    SHAW    niLLINGS — GARRISON 

ber  7,  1880),  was  charged  with  the  same  sagacit\-  and  humor 
as  the  above  and  made  a  deep  impression.  In  relation  to  the 
stationary  character  of  the  legal  mind  and  the  intrigues  of 
medical  politicians,  he  urges  his  fellow  sanitarians  to  persevere 
bravely,  even  though  "like  Saul,  the  son  of  Kish,  they  go  forth 
to  find  their  father's  asses,  and  they  don't  have  to  hunt  long." 

In  November,  1879,  ^r.  Billings,  in  co-operation  with  Dr. 
Charles  F.  Folsom,  Col.  George  E.  Waring,  Jr.,  and  other 
members  of  the  National  Board  of  Health,  made  a  sanitary 
survey  of  Memphis,  Tennessee,  following  the  epidemic  of  yel- 
low fever  in  the  city  in  the  summer  of  that  year.  His  recom- 
mendations were  adopted  and  carried  out  at  the  instance  of 
the  original  committee  of  fifteen  appointed  by  the  city  itself, 
and  his  visit  was  described  as  "a  moral  tonic"  in  the  local  news- 
papers. He  summed  up  his  views  of  yellow  fever  in  a  remark- 
able article  in  the  International  Review  of  January,  1880.  In 
this  he  points  out  that  the  probable  cause  of  the  disease  is  "a 
minute  organism  somewhat  like  the  yeast  plant,  or  it  may  be 
the  product  of  such  an  organism,  like  alcohol" ;  that  the  clin- 
ical phenomena  resemble  those  of  snake  bite ;  that  yellow  fever 
occurs  near  old  wharves,  piers,  ships,  wooden  pavements,  and 
other  structures  of  decaying  wood  or  in  connection  with  huge 
piles  of  decaying  seaweed,  dead  fish,  etc.,  on  the  Gulf  coast; 
that  clouds  of  smoke  from  the  burning  of  infected  bedding 
in  the  streets  are  as  the  very  wings  of  pestilence  in  conveying 
the  infection,  and  that  exposure  and  shaking  of  textiles  in  cold 
weather  for  three  or  four  nights  will  avail  to  disinfect  them. 
His  citation  of  the  old  farmer's  adage  that  "yellow  fever  can't 
go  anywhere  unless  yer  tote  it,"  shows  how  close  he  was  upon 
the  theory  of  convection  of  yellow  fever  by  mosquitoes. 

During  the  twenty  years  preceding  his  retirement  from 
active  service  in  the  army  (1895),  Dr.  Billings  was  regarded 
as  the  leading  authority  on  public  hygiene  in  this  country,  and 
his  services  and  advice  were  in  request  everywhere.  During 
i879-'83,  he  published  in  the  Plumber  and  its  successor,  the 
Sanitary  Engineer,  a  series  of  "Letters  to  a  Young  Architect 
on  Ventilation  and  Heating,"  which  were  the  basis  of  his  "Prin- 
ciples of  Ventilation  and  Heating"  (1884),  and  were  repub- 
lished in  enlarged  form  in  1893.     In  1879,  he  furnished  the  in- 

395 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

troductory  chapter  on  hygiene  and  its  jurisprudence  to  A.  H. 
Buck's  treatise  (Ziemssen's  Handbuch),  which  was  the  germ 
of  two  separate  treatises  on  h3^giene  published  in  William 
Pepper's  System  of  Medicine  (1885,  1893).  In  connection 
with  his  general  sanitary  work,  he  wrote  a  large  number  of 
papers  for  the  medical  periodicals  bearing  on  all  aspects  of  the 
subject,  e.  g.,  those  on  vaccination  (1882),  house  sanitation  in 
large  cities  (1882),  heating  and  ventilation  of  a  school  build- 
ing (1882),  sewage  disposal  in  cities  (1885),  water  supply  for 
small  towns  (1889),  house  drainage,  a  paper  of  great  prac- 
tical value  for  householders  and  housewives  (1889),  public 
health  and  municipal  government  (1891),  municipal  sanitary 
defects  in  American  cities  (1893),  and  studies  of  municipal 
sanitation  in  Washington  and  Baltimore  (1893),  New  York 
and  Brooklyn  (1894),  Boston  and  Philadelphia  (1894).  Dur- 
ing i876-'82,  he  gave  expert  opinion  on  the  ventilation  of  the 
hall  of  the  House  of  Representatives ;  his  letter  books  reveal 
a  vast  amount  of  correspondence  in  which  his  unique  knowl- 
edge and  experience  as  a  ventilating  engineer  were  in  con- 
stant evidence,  whether  for  a  private  club  in  Baltimore  or  in 
the  construction  of  a  large  hospital  laboratory,  museum  or 
library.  His  early  dream  of  making  a  sanitary  survey  of  the 
United  States  was  occasionally  realized  in  such  isolated  cases 
as  those  of  Memphis  (i879-'8o)  and  St.  Augustine,  Florida 
(1892). 

During  the  late  eighties,  Dr.  Billings  was  lecturing  on  hy- 
giene at  the  School  of  Mines,  New  York,  and,  in  1889,  he 
signed  an  agreement  with  the  University  of  Pennsylvania  to 
assume  the  directorship  of  the  University  Hospital  on  January 
I,  1890,  to  prepare  plans  for  a  laboratory  of  hygiene  after 
studying  the  best  hygienic  laboratories  in  Europe,  and  to 
assume  the  professorship  of  hygiene  in  the  university.  His 
lectures  on  hygiene  and  vital  statistics  began  during  the  aca- 
demic session  of  i89i-'2,  the  subject  of  bacteriology  being 
treated  by  Dr.  A.  C.  Abbott.  Upon  his  retirement  from  active 
service  in  the  army  in  1895,  he  became  full  professor  of 
hygiene  at  the  university,  continuing  his  lectures  until  June  1, 
1896,  when  he  became  director  of  the  New  York  Public 
Library.    During  his  Philadelphia  incumbency,  he  planned  and 

396 


JOFIN    SIIAW    BILLINGS — GARRISON 

opened  the  Laboratory  of  Hyg^iene  of  the  University  (1892) 
and  the  William  Pepper  Laboratory  of  Clinical  Medicine 
(1895).  Among  the  memoirs  of  original  investigations  made 
in  the  Laboratory  of  Hygiene,  which  were  presented  to  the  Na- 
tional Academy  by  Billings,  were  the  study  of  his  pupil  James 
Homer  Wright  on  the  bacteria  of  the  Schuylkill  River  ( 1894), 
which  led  in  some  measure  to  the  construction  of  the  great 
Belmont  filtration  plant  in  Philadelphia ;  and  the  researches 
made  by  Miss  Adelaide  Ward  Peckham  on  "The  Influence  oi 
Light  upon  the  Bacillus  of  Typhoid  and  the  Colon  Bacillus" 
(1894)  and  "On  the  Influence  of  Insolation  upon  Culture 
Media  and  of  Desiccation  upon  the  Vitality  of  the  Bacillus  of 
Typhoid,  of  the  Colon  Bacillus  and  of  the  Staphylococcus 
Pyogenes  Aureus"  (1894).  Two  other  memoirs,  published 
by  the  Smithsonian  Institution,  were  "The  Influence  of  Certain 
Agents  in  Destroying  the  \"itality  of  the  Typhoid  and  of  the 
Colon  Bacillus,"  by  Miss  Peckham  (1895)  ^"^  "The  Comi)nsi- 
tion  of  Expired  Air  and  Its  Effects  upon  Animal  Life,"  by 
Billings,  Weir  Mitchell  tmd  D.  H.  Bergey  (1895).  -Billings 
was  in  actual  residence  at  the  University  of  Pennsylvania  for 
a  period  of  eight  months  only.  During  his  earlier  career  in 
hygiene  he  had  belonged  to  the  older  or  philosophical  school  of 
sanitarians,  of  whom  Pettenkofer  was  the  type,  but  the  work 
done  under  his  direction  during  his  short  Philadelphia  period 
shows  that  he  fully  appreciated  and  understood  the  advances 
made  by  the  ney^er  or  "bacteriological"  school. 

From  the  time  of  his  celebrated  report  on  the  barracks  and 
hospitals  of  the  United  States  Army  (1870),  Billings  had  been 
specially  interested  in  the  subject  of  hospital  construction.  His 
real  career  as  a  practical  expert  and  authority  in  this  field,  in 
which  he  made  an  epoch,  began  in  1876,  when  he  was  selected 
by  the  trustees  of  the  Johns  Hopkins  Fund  to  be  their  medical 
adviser  in  the  planning  and  construction  of  the  hospital  speci- 
fied in  the  will  of  Johns  Hopkins  himself.  On  March  6,  1875. 
the  trustees  sent  out  a  circular  letter  to  fi^'e  experts  on  hospital 
construction  in  the  United  States  requesting  plans  for  the  pro- 
posed structure,  and  of  these  plans  that  of  Dr.  Billings  was 
selected  as  the  best,  combining  as  it  did  the  advantages  of  a 
central  pavilion  with  detached  buildings  as  hospital  units,  in- 

397 


NATIONAL   ACADKMY   BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

eluding  first-class  physiological  and  pathological  laboratories, 
a  separate  dispensary  for  out-patient  relief  and  instruction  of 
students,  two  pharmacies,  and  a  training  school  for  nurses.  It 
was  specified  that  the  administration  should  be  upon  the  mili- 
tary or  railroad  plan,  under  one  head  and  one  only;  that  clin- 
ical instruction  should  be  given  usually  in  the  wards  and  out- 
patient department  and  not  in  any  clinical  amphitheater,  except 
in  the  surgical  unit ;  that  medical  cases  should  not  be  brought 
from  beds  to  an  amphitheater ;  that  there  should  be  graded 
accommodations  for  pay  and  private  patients  in  rooms  or 
suites  of  rooms ;  that  a  perfect  system  of  records,  financial,  his- 
torical, and  clinical  should  be  kept,  and  that  annual  volumes  of 
reports,  made  up  of  original  scientific  work,  should  be  pub- 
lished. All  these  were  absolutely  new  ideas  in  hospital  con- 
struction and  administration  in  this  country,  a  fresh  departure 
from  the  many-storied  block  hospitals  of  the  past  and  the 
detached  rambling  wooden  pavilions  of  the  Civil  War.  The 
administrative  ideal  was  not  only  the  proper  care  of  the  sick 
poor,  but  graded  accommodations  for  patients  of  different 
means  and  stations  and,  above  all,  the  scientific  education  of 
physicians  and  nurses  and  the  promotion  of  "discoveries  in  the 
science  and  art  of  medicine"  and  their  publication.  For  some 
seventeen  years,  up  to  the  opening  of  the  Johns  Hopkins  Hos- 
pital on  May  7,  1889,  Billings  labored  over  the  revision  and 
perfection  of  his  original  plans,  frequently  visiting  the  best 
European  hospitals  during  his  trips  abroad,  lecturing  and 
advising  with  the  trustees  and  university  authorities  as  to 
ways  and  means  of  finance  and  administration,  and  conferring 
with  President  Oilman  and  Professors  Welch,  Remsen,  and 
Newell  Martin  as  to  the  curriculum  of  the  future  medical 
school.  It  was  Billings  who  advised  the  selection  of  Welch 
and,  five  years  later,  of  Osier  as  leaders  of  the  medical  faculty. 
The  hospital,  when  completed  and  opened,  was  recognized 
everywhere  as  the  finest  in  existence  at  the  time.  A  full 
account  of  it  will  be  found  in  Billings's  "Description  of  the 
Johns  Hopkins  Hospital"  (1890),  which  became  a  sort  of  text- 
book on  the  subject  of  hospital  construction  and  ventilation, 
and  is  still  used  and  consulted.  In  addition  to  the  Johns  Hop- 
kins Hospital,  Billings  supervised  the  planning  and  construc- 

398 


JOHN    SHAW    BILLINGS — GARRISON 

tion  of  the  Barnes  Hospital  of  Soldiers'  Home,  D.  C.  (1873), 
the  Army  Medical  Museum  (1887).  the  Laljoratory  of  Hygiene 
(1892)  and  the  William  Pepper  Laboratory  of  Clinical  Medi- 
cine (1895)  in  Philadelphia,  the  New  York  Public  Library 
(1911)  and  the  Peter  !)ent  Urigham  Hospital  at  I'.oston 
(1913).  In  the  science  of  hospital  construction  he  was  entirely 
self-taug-ht,  as  also  in  the  complex  details  of  sanitary  engineer- 
ing, in  which  his  expert  knowledge  and  skill  were  of  the  best 
order.  He  had  a  wonderfully  keen  eye  for  detecting  the  strong 
and  weak  points  in  any  new  set  of  plans  and  specifications 
just  set  before  him.  One  stenographic  report  of  his  otT-hand 
discussion  of  the  plans  proposed  for  the  new  City  Hos])ital  at 
Memphis,  Tennessee  (1897),*  is  a  remarkable  example  of  his 
quickness  in  this  regard.  Of  this  phase  of  Billings's  talents 
President  Woodward  of  the  Carnegie  Institution  (^^'ashing- 
ton)  has  remarked  that  "few  engineers  and  few  architects 
whom  I  have  had  the  good  fortune  to  meet  could  more  quickly 
read  a  set  of  plans  and  specifications  and  hit  upon  the  critical 
points  to  be  considered." 

Billings  \vas  one  of  the  most  accomplished  statists  of  modern 
times,  and  with  the  late  Gen.  Francis  A.  Walker,  who  was 
superintendent  of  the  ninth  and  tenth  U.  S.  Census,  perhaps 
the  leading  American  authority  on  statistics  in  his  day.  On 
October  15,  1878,  Billings  transmitted,  through  Surgeon- 
General  J.  K.  Barnes,  a  letter  sent  to  the  Honorable  S.  S. 
Cox,  chairman  of  the  Committee  of  the  Census  of  1880.  in 
wdiich  some  very  valuable  suggestions  were  made  as  to  the 
advisability  of  including  medical  statistics,  particularly  those 
of  disease-incidence,  along  with  the  data  usually  given  as  to 
births  and  mortality.  He  cites  the  experience  of  the  Royal 
Sanitary  Commission  of  England  that,  "however  complete  the 
registration  of  deaths  may  be,  it  cannot  give  a  fair  estimate 
of  the  sickness  which  is  not  fatal,  it  cannot  indicate  where  or 
how  these  are  to  be  prevented,  it  cannot  tell  the  cost  which  is 
worth  incurring  for  their  diminution."  At  this  time,  it  ap- 
peared that  the  only  countries  which  attempted  to  obtain  a 
registration  of  disease  in  connection  with  the  national  census 


*  Memphis  Med.  Monthly.   \?g7,  xvii,  10,^.  249.  309. 

399 


NATIONAI^   ACADEMY    RIOCRAPHICAL    MEMOIRS — VOL.  VIII 

were  Ireland,  where  a  record  of  diseases  with  which  individ- 
uals might  be  sui^ering  on  the  day  of  the  count  was  made  in 
the  patient's  own  words,  often  in  Irish ;  and  Portugal.  The 
chief  obstacle  to  the  making  of  such  records  was  that  the 
questions  had  usually  to  be  put  and  answered  by  unprofes- 
sional men.  Billings  suggests  a  series  of  questions  eliciting 
information  as  to  the  number  of  days  the  person  is  unable  to 
follow  his  avocations  or  attend  school  through  the  year  on 
account  of  disease  or  injury,  the  disease  or  injury  from  which 
the  person  might  be  suffering  on  the  day  of  the  count,  the 
mode  of  treatment,  whether  private,  public  (charitable)  or  in 
hospital,  the  particular  incidence  of  specific  infectious  diseases 
during  the  year,  if  any,  and  data  as  to  loss  of  wages  and  cost 
of  medical  attendance,  medicines,  and  nursing.  From  this 
time  on  (1878-1912),  Billings  was  active  and  prominent  in  the 
supervision  of  the  vital  statistics  of  the  Tenth,  Eleventh,  and 
Twelfth  Census  of  the  United  States  (1880-1900).  Of  this 
phase  of  his  work  a  competent  reviewer  in  the  London  Times 
(July  22,  1915),  states  that:  "Before  1880,  when  Dr.  Billings 
took  charge  of  the  vital  statistics  of  the  United  States  Census, 
they  were  worse  than  worthless.  For  three  decades — the 
Tenth,  Eleventh,  and  Twelfth  Census- — Dr.  Billings  was  a  vol- 
unteer worker  in  this  field  of  statistical  inquiry,  and  from  a 
state  of  chaos  he  brought  the  vital  statistics  of  the  United 
States  to  their  present  satisfactory  condition." 

Billings's  reports  on  the  mortality  and  vital  statistics  of  the 
Tenth  Census  (i885-'6)  consist  of  two  stout  volumes,  with  an 
atlas  of  plates  and  diagrams.  In  these  reports,  the  figures 
furnished  him  were  subjected  to  modern  methods  of  analysis 
and  interpretation  and  new  data  as  to  racial  equation  and  race- 
incidence  in  disease  were  elicited  by  processes  of  statistical 
induction.  Some  of  these  data  have  been  uniformly  quoted 
in  modern  text-books  on  practice  of  medicine.  In  1880,  Billings 
had  suggested  that  the  various  statistical  data  of  the  living 
and  the  decedent  "might  be  recorded  on  a  single  card  or  slip 
by  punching  small  holes  in  it,  and  that  these  cards  might  then 
be  assorted  and  counted  by  mechanical  means  according  to  any 
selected  group  of  these  perforations." '     This  suggestion  was 


■'  Proc.  Amcr.  Assoc.  Adv.  Sc,  1891,  Salem,  1892,  xl,  407-409. 

400 


JOHN    SHAW    BILLINGS GARRISON 

taken  up  and  applied  by  the  inventor,  Mr.  Herman  Hollerith, 
in  the  electrical  counting-  and  integratini;-  machines  which  are 
now  employed  by  the  United  States  Census.      I'illings  also  in- 
troduced new  wrinkles  as  to  the  modes  of  tabulation  of  vital 
statistics   and  the  use  of  circles   with  multicolored  sectors  to 
represent  various  aspects  of  mortality  and  disease  incidence. 
At  the  Tenth  International  Congress  at  Berlin  (1890),  he  pro- 
posed a  definite  scheme  for  securing  international  uniformity 
in  medico-military  statistics.     In  connection  with  the  Eleventh 
Census   (1890J,  he  made  valuable  special  reports  on  the  vital 
statistics  of  the  Jews  in  the  United  States   (1890),  the  social 
statistics  of  cities  (1891),  the  vital  statistics  of  the  District  of 
Columbia    and   Baltimore    (1893),    New   York   and    Brooklyn 
(1894),  Boston  and  Philadelphia  (1895).  and  the  special  sta- 
tistics  of  the   insane,    feeble-minded,   deaf,   dumb,    and   blind 
(1895).     To  the  Twelfth  Census  he  contributed  an  anahsis 
of  its  vital  statistics  (1904).     To  the  theory  of  vital  and  med- 
ical  statistics    he    made   three   separate   contributions,   viz.,   a 
series  of  papers  published  in  the  Sanitary  Engineer  (i883-'5), 
his  Cartwright  Lectures,  delivered  before  the  College  of  Physi- 
cians of  New  York  in  1889,  and  a  memoir  published  as  part 
of  the  prolegomena  to  Sir  Clififord  Allbutt's  System  of  Medi- 
cine (1896).     In  all  these  his  familiarity  with  the  mathematical 
methods  employed  by   Farr,   Rumsey,   Korosi   and  the  other 
writers  before  Karl  Pearson  is  evidenced,  and  the  conclusion 
of  his  Cartwright  Lectures  shows  that  he  understood  the  falla- 
cies and  inadequacies  of  the  older  methods  and  saw  clearly  the 
need  of  the  "correlations"  subsequently  employed  by  Pearson. 
In  his  presidential  address  before  the  Seventeenth  Interna- 
tional Congress  of  Medicine  at  London  (August  6,  1913).  Sir 
Thomas  Barlow,  in  naming  the  eminent  physicians  who  had 
been  prominent  at  the  London  Congress  of  1881,  referred  to 
Billings  as  "prince  of  medical   bibliographers."     In  this  field 
Billings  with  his  colleague  Fletcher  were,  indeed,  the  succes- 
sors  of   Haller,    who   catalogued   the    literature   of   anatomy, 
surg^ery,  internal  medicine,  and  botany  up  to  the  last  (juarter 
of  the  eighteenth  century,  and  Callisen,  who  indexed  the  entire 
medical  literature  of  the  last  half  of  the  eighteenth  century 
and  the  first  third  of  the  nineteenth.     Billings's  achievement  in 

401 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIIl 

this  matter  is  a  wonderful  lesson  in  the  utilization  of  oppor- 
tunities as  they  come  and  was  the  fulfillment  of  a  dream  of 
his  youth.  In  his  reminiscences  of  his  old  medical  alma  mater, 
read  in  1888,  he  has  described  his  almost  futile  attempts  to 
obtain  complete  statistics  of  operations  for  his  graduating  dis- 
sertation on  epilepsy  from  the  then  medical  libraries  of  the 
country  (1861),  and  his  realization  of  the  fact  that,  while 
there  was  not  a  library  in  the  world  containing  all  the  litera- 
ture of  medicine,  there  was  not  even  a  fairly  good  collection 
(jf  such  literature  in  the  United  States,  so  that  exhaustive 
research  in  this  field  would  require  a  visit  to  several  libraries 
in  Europe.  "It  was  this  experience,"  he  says,  "which  led 
me,  when  a  favorable  opportunity  offered  at  the  close  of  the 
war,  to  try  to  establish  for  the  use  of  American  physicians  a 
fairly  complete  medical  library,  and  in  connection  with  this  to 
prepare  a  comprehensive  catalogue  and  index  which  should 
spare  medical  teachers  and  writers  the  drudgery  of  consulting 
ten  thousand  or  more  different  indexes  or  of  turning  over  the 
leaves  of  as  many  volumes  to  find  the  dozen  or  so  references 
of  which  they  might  be  in  search." " 

Prior  to  1836,  there  existed  in  the  Surgeon-General's  Office 
at  Washington  a  small  departmental  outfit  of  medical  books 
which  had  been  gathered  for  the  official  use  of  Surgeon-Gen- 
eral Joseph  Lovell  (appointed  1818).  When  Billings  was 
assigned  to  duty  in  this  office  on  December  31,  1864,  the  col- 
lection, which  had  been  increased  at  intervals  bv  Surgeon- 
General  William  A.  Hammond  and  his  successors,  amounted 
to  some  1,365  volumes.  To  Billings  was  assigned,  among  other 
things,  nominal,  if  not  official,  care  of  this  collection.  Small 
printed  catalogues  of  this  tiny  medical  library  had  been  issued 
from  time  to  time,  that  of  October  23,  1865,  showing  2,253 
volumes.  At  the  close  of  the  Civil  War  there  existed  a  con- 
siderable "slush  fund"  turned  in  from  the  army  hospitals  and 
derived  "from  the  sale  of  bones,  fat,  stale  bread,  slops,  flour 
barrels,  straw,  manure,  waste  paper,  old  newspapers,  etc.,  and 
from  the  tax  on  the  sutler."  '     This  slush  fund,  amounting  to 

*  Cincinnati  Lancet-Clinic,  1888,  n.  s.,  xx,  297. 

'  Med.  &  Surg.  Hist.  War  of  Rebellion,  Washington,  1888,  Med.  Vol. 
iii.  959- 

402 


JOHN    SHAW    BILLINGS — GARRISON 

about  $80,000,  Billings  was  permitted  to  use  for  the  purchase 
of  books  for  the  Surgeon-Generars  Library,  the  subsequent 
catalogues  of  which  made  a  showing  of  6.066  volumes  in  186H 
and  13,330  volumes  in  1871.  In  1873,  Billings  issued  a  three- 
volume  author  catalogue,  with  some  subject  entries,  showing 
a  quota  of  about  25,000  volumes  and  15,000  individual 
pamphlets.  In  1876,  he  utilized  his  studies  in  nosology  in  the 
publication  of  a  "Specimen  Fasciculus  of  a  Catalogue  of  the 
National  Medical  Library  under  the  direction  of  the  Surgeon- 
General,  United  States  /\rmy,"  consisting  of  a  specimen  index 
of  authors  and  subjects  arranged  in  dictionary  order  in  a  single 
alphabet,  which  was  submitted  to  the  medical  profession  for 
criticisms  and  suggestions.  At  this  time,  the  library  contained 
some  40,000  volumes  and  about  the  same  number  of  pamphlets. 
The  Specimen  Fasciculus  was  regarded  with  great  interest  and 
favor  by  the  profession,  and  received  enthusiastic  commenda- 
tion from  Dr.  Oliver  Wendell  Holmes  in  his  dedicatory  ad- 
dress at  the  opening  of  the  Boston  Medical  Library  on  Decem- 
ber 3,  1878.  Meanwhile  Billings  had  acquired  the  necessary 
appropriation  from  Congress  for  increasing  and  completing 
his  collections  and  on  September  i,  1876,  gained  the  valuable 
assistance  of  Dr.  Robert  Fletcher,  of  Bristol,  England,  an  army 
surgeon  of  the  Civil  War,  who  was  to  be  his  faithful  coadjutor 
in  this  work  for  the  next  twenty  years  and  his  successor  for 
seventeen  years  afterward.  In  1880,  he  at  length  obtained  the 
necessary  Congressional  appropriation  for  printing  a  complete 
Index  Catalogue  of  the  library,  and  the  first  volume  of  this 
publication,  a  stout  quarto  of  888  pages,  covering  the  litera- 
ture by  authors  and  subjects  from  A  to  Berlinski,  was  issued 
in  the  same  vear.  Similar  volumes  of  the  same  dimensions 
were  issued  annually  up  to  the  completion  of  the  first  series  in 
1895,  when  Dr.  Billings  was  retired  from  active  service  in  the 
army.  The  second  series  (volumes  I-XA'II)  was  carried  on 
by  Dr.  Fletcher  up  to  the  day  of  his  death  (November  8,  1912), 
and  is  now  complete  in  21  volumes  (1916).  the  two  series 
comprising  37  volumes.  In  this  publication,  the  entire  litera- 
ture of  medicine  and  its  collateral  subjects  from  the  earliest 
times  down  to  the  year  1916  is  indexed  in  alphabetical  order 
by  authors  and   subjects,  the  latter  indicated  by   appropriate 

403 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

rubrics  in  bold-faced  type,  with  abundant  cross  references. 
When  we  reaHze  that  most  of  the  important  hterature  of  nine- 
teenth and  twentieth  century  medicine  is  buried  in  the  files  of 
medical  periodicals,  the  magnitude  and  importance  of  the  task 
of  indexing  it  seriatim  is  plain.  Of  this  work  Billings  was  not 
only  the  organizer  and  promoter,  but  for  thirty  years  he  se- 
lected and  bought  the  literature  from  publishers'  and  anti- 
quarian catalogues,  checked  for  indexing  all  the  periodicals  as 
they  came  in,  devised  the  system  of  subject  classifications  and 
cross  references  and  read  the  final  revises  of  the  proofs,  to  the 
galley  sheets  of  which  Dr.  Fletcher  gave  his  rare  scholarship 
and  critical  acumen.  In  the  earlier  days,  bound  periodicals 
by  the  vanload  were  left  daily  at  Billings's  residence  for  check- 
ing, the  work  sometimes  occupying  him  until  the  small  hours 
of  the  night.  The  day  was  spent  in  administrative  duties  and 
in  training  the  clerical  force  (most  of  them  old  hospital  stew- 
ards) in  the  details  of  indexing,  preparing  copy  and  other 
library  work.  After  Dr.  Billings's  retirement  the  classifica- 
tion, redaction  and  proof-reading  of  the  second  series  of  the 
Index  Catalogue  was  superintended  by  Dr.  Fletcher  up  to  the 
time  of  his  death  (1896-1912).  The  Index  Catalogue  was  an 
unusual  thing  to  come  out  of  a  new  country,  but  its  enormous 
value  to  the  medical  profession  and  to  librarians  was  soon 
recognized  all  over  the  world.  The  copies  on  hand  in  the 
larger  medical  libraries  have  frequently  to  be  rebound  on 
account  of  constant  handling  and  Sir  William  Osier  has  re- 
lated how  worn  and  much  bethumbed  are  the  copies  in  Euro- 
pean libraries.  As  a  monthly  supplement  to  the  Index  Cata- 
logue, the  Index  Medicus,  an  extra-official  publication  giving 
a  classified  record  of  the  current  medical  literature  of  the 
world,  month  by  month,  was  begun  by  Dr.  Billings  and  Dr. 
Fletcher  in  1879,  the  redaction  of  this  publication  being  prin- 
cipally in  the  hands  of  Dr.  Fletcher.  The  annual  index  of  the 
twelve  monthly  numbers  comprises  a  complete  conspectus  of 
the  author  entries  in  alphabetical  order  and  a  minutely  subdi- 
vided subject  index  which  is,  in  respect  of  classification,  a  sort 
of  annual  Index  Catalogue  en  miniature.  The  first  series  of 
the  journal  ran  through  21  volumes  (1879-99),  when  it  died 
out  from  lack  of  financial  support.     In  1903  the  Index  Medicus 

404 


JOHN    SHAW    BILrUNGS — GARRISON 

was  revived  under  the  financial  patronage  of  the  Carnegie 
Institution  of  Washington,  with  Dr.  Fletcher  as  cdilor-in-chicf 
(1903-T911)  and  is  still  current. 

In  building  up  his  unique  collections  whicli,  under  Col. 
Champe  C.  McCulloch's  administration,  now  number  226,128 
volumes,  337,110  pamphlets,  and  5,249  portraits  of  physicians. 
Billings  did  not  rest  content  with  Congressional  appropriations, 
but  in  his  restless  indefatigable  way  aimed  to  complete  his 
periodical  files  and  fill  up  lacunar  as  far  as  possible  by  a  reso- 
lute fairc  Heche  de  tout  hois.  To  this  end,  he  kept  on  hand 
large  quantities  of  duplicates,  which  he  personally  fostered  for 
exchange  purposes,  sent  out  endless  trains  of  letters  to  secure 
public  documents  and  accessions  by  gift,  where  possible,  and 
ransacked  all  private  collections  which  were  thrown  open  to 
him  for  rare  items.  Dr.  Holmes  has  humorously  described 
how  Billings  entered  his  private  library  at  Cambridge  and 
immediately  swooped  down  upon  the  most  valuable  things  on 
his  shelves.  "Why,  sir,"  he  said,  "Dr.  Billings  is  a  bibliophile 
of  such  eminence  that  I  regard  him  as  a  positive  danger  to  the 
owner  of  a  library  if  he  is  ever  let  loose  in  it  alone."  In  still 
hunts  of  this  kind,  his  right-hand  man  was  the  late  Thomas 
Windsor,  an  ophthalmic  surgeon,  of  Manchester,  England,  who 
died  in  1910,  leaving  the  most  valuable  items  in  his  collection 
to  the  Surgeon-General's  Library.  Windsor  was  an  eccentric, 
Avho,  like  Landor,  would  give  away  any  book  about  him  if  it 
suited  his  whim,  but  would  stickle  to  the  last  farthing  in  the 
adjustment  of  his  accounts  with  a  public  institution.  Eccen- 
tric were  the  provisions  of  his  will,  which  stipulated  that  his 
executors  should  spend  as  little  as  possible  on  his  funeral,  in- 
vite no  one  to  it,  and  insert  no  notice  of  his  death  in  the  news- 
papers, while  some  £20,000  of  his  estate  were  to  be  used  for 
the  relief  of  suffering  in  any  way,  provided  that  nothing  should 
be  given  to  any  hospital,  dispensary,  medical  society  or  insti- 
tution, nor  to  any  church  or  any  charity  subject  to  a  religious 
body  or  sect.  Yet  he  was  a  bibliophile  of  rarest  talents  and 
enthusiasm.  From  his  country  seat,  "The  Polygon"  (Ard- 
wick),  letter  after  letter  went  out  in  quest  of  rare  items  for 
the  Surgeon-General's  Library,  the  historical  collections  of 
which  he  did  much  to  complete,  early  and  late.     He  had  a  kind 

405 


NATIONAL   ACADE;MY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

of  supernatural  flair  for  locating  rare  items  in  antiquarian 
book  shops.  When  in  Washington  he  would  smilingly  extract 
such  things  from  the  shelves  of  the  local  establishments  like 
rabbits  from  a  conjurer's  hat. 

Through  his  lectures  and  writings  on  the  history  of  medi- 
cine, Billings  was  one  of  the  original  prime  movers  in  the  devel- 
opment of  its  study  and  investigation  in  the  United  States. 
From  the  date  of  the  earliest  contribution  to  the  subject  made 
in  this  country,  the  "Medical  Discourse"  of  Dr.  Peter  Middle- 
ton  (New  York,  1769),  little  had  been  done  until  Dr.  Oliver 
Wendell  Holmes,  in  1842,  began  to  write  those  brilliant,  witty, 
and  learned  papers  which  eventually  made  up  his  "Medical 
Essays"  (1883),  the  most  important  American  work  dealing 
with  medical  history  in  its  day.  In  1876,  Billings  published  his 
centennial  survey  of  American  medical  literature  (noticed  be- 
low), which  was  just  and  critical  even  to  the  point  of  nil 
admirari.  In  1881,  he  was  asked  to  deliver  one  of  the  general 
addresses  at  the  International  Medical  Congress,  choosing  as 
his  subject  "Our  Medical  Literature,"  a  genial,  if  critical,  ex- 
amination of  the  world's  medical  literature  at  the  time.  This 
discourse,  replete  with  wit  and  wisdom,  made  a  deep  impres- 
sion, is  still  remembered  and  read  and  ranks  with  the  earlier 
essays  of  Holmes  and  Toner,  Weir  Mitchell's  history  of  in- 
strumental precision  in  medicine  and  the  later  studies  of  Osier, 
Welch,  Jacobi,  Fletcher,  and  Kelly,  as  among  the  few  contri- 
butions of  permanent  value  made  to  the  subject  of  medical 
history  in  this  country.  Worthy  of  especial  mention  are  Bill- 
ings's history  of  medical  libraries  in  the  United  States  (1876), 
his  addresses  on  "Medical  BibHography"  (1883)  and  on 
"Methods  of  Research  in  Medical  Literature"  (1887),  which, 
in  connection  with  his  model  bibliographies  of  cholera  (1875) 
and  alcoholism  (1894),  became,  as  it  were,  texts  and  reference 
manuals  among  the  medical  librarians ;  his  "National  Medical 
Dictionary"  (1885),  a  collaborative  work  giving  all  the  med- 
ical termini  technici  in  English,  French,  German,  and  Italian; 
his  alumni  address  on  "The  Medical  College  of  Ohio  Before 
the  War"  (1888)  ;  his  bantering  consideration  of  "American 
Inventions  and  Discoveries  in  Medicine,  Surgery,  and  Practical 
Sanitation,"  read  at  the  bicentennial  of  the  American  patent 

406 


JOHN    SHAW    BILLINGS — GARRISON 

system  (1891);  his  contribution  to  the  history  of  the  Smith- 
sonian Institution  (1897);  his  survey  of  the  "Progress  of 
Medicine  in  the  Nineteenth  Century"  (1900)  ;  and  his  " History 
of  Surgery"  (1895),  which  still  remains  the  best  work  on  the 
subject  in  English.  In  1877-8  and  some  years  after,  Billings 
gave  a  regular  course  of  lectures  on  the  history  of  medicine  at 
the  Johns  Hopkins  University.  Another  course  was  delivered 
at  the  Lowell  Institute  in  1888.  These  were  never  published, 
with  the  exception  of  the  introductory  Lowell  lecture  on  med- 
ical folklore,  which  is  highly  original.  He  was  one  of  the 
founders  of  the  Charaka  Club  in  New  York  City  (1898),  and 
in  1906  read  before  it  a  suggestive  paper  on  "The  King's  Touch 
for  Scrofula." 

In  the  advancement  of  medical  education  and  in  the  improve- 
ment of  the  general  condition  of  medicine  in  this  country. 
Billings  played  a  leading  part  for  at  least  thirty  years.  The 
secret  of  his  influence  lay  partly  in  his  character,  which  was 
forceful,  aggressive,  firm,  self-reliant,  but  mainly  in  the  quality 
of  his  mind,  his  cool  detachment,  his  wonderful  sagacity  and 
insight.  In  this  relation,  he  early  made  his  mark  in  his  abso- 
lutely straightforward  advice  and  suggestions  to  the  Johns 
Hopkins  Hospital  trustees  in  regard  to  the  best  needs  of  the 
future  medical  school.  These  were  delivered  in  a  way  which 
proved  absolutely  convincing  through  their  blunt  honesty  and 
transparent  sincerity,  as  of  a  man  Ialx)ring  under  no  illusions. 
Thus  Billings  soon  gained  the  highest  reputation,  at  home  and 
abroad,  for  that  rare  virtue,  unfailing  reliability  of  character 
and  judgment.  His  lectures  on  medical  education  (1878)  and 
his  "Condensed  Statement"  of  the  requirements  of  the  prin- 
cipal European  universities  for  graduation  in  medicine  (1893) 
were,  with  a  letter  sent  by  the  late  Sir  Henry  Acland  to  the 
hospital  trustees  in  1879,  of  greatest  value  to  the  Johns  Hop- 
kins University  and  other  American  institutions.  Through  his 
later  life  he  continued  to  stimulate  interest  in  the  subject 
through  various  wise  discourses,  such  as  those  on  "Ideals  of 
Medical  Education"  (Yale,  1891),  on  "Hygiene  in  University 
Education"  (Oxford,  1894),  his  address  to  the  graduating 
class  of  Bellevue  Hospital  Medical  College  (1882),  which  is 
a  delightful  burlesque  of  the  platitudes  usually  delivered  by  the 

407 


NATIONAL,   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

valedictorian  and  the  tender  of  diplomas,  and  his  speech  before 
the  Harvard  Medical  Alumni  Association    (1894).     On  the 
general  advance  of  medicine  in  the  country  the  influence  of  his 
critical,   humorous,   sagacious  spirit  was  no  less  remarkable. 
In  1876,  Billings  published,  in  the  volume  A  Century  of  Amer- 
ican Medicine,  a  centennial  survey  of  the  medical  literature  and 
institutions  of  the  United  States  which,  in  its  extremely  critical 
tendency,  marked  a  great  advance  upon  the  laudatory  and  lapi- 
dary expressions  of  our  earlier  writers  upon  this  theme.     In 
this  regard,  the  very  titles  of  some  of  our  earlier  (and  happily 
short-lived)    medical  periodicals — The  Granite  State  Medical 
Revolutionist  and  Hygienic  Advertiser,   The  Georgia  Blister 
and  Critic,  The  St.  Louis  Probe,  The  Indiana  Scalpel,  The 
Drug  Mill,  The  Medical  Waif,  The  Quarterly  Review  of  Nar- 
cotic Inebriety,  The  Dental  Jairus — speak  for  themselves.    The 
writers    of    the    time,    in    the   expressive    words    of    Holmes, 
"chewed  the  juice  out  of  all  the  superlatives  in  the  language 
in  Fourth  of  July  orations,"  and  this  florid,  stilted,  uncritical 
spirit   was   not   confined   to   the   vulgar,    indeed   attained    its 
apogee  among  the  learned  in  the  otherwise  admirable  discourse 
on  "Silver  Sutures  in  Surgery"  (1857),  by  Marion  Sims,  the 
founder  of  modern  operative  gynaecology.     Billings  was  at  no 
time  inclined  to  wear  "the  foolish  face  of  praise."     His  stric- 
tures upon  the  status  of  our  medical  literature,  just  but  kindly 
meant,    gave    considerable    offense    in   certain    quarters.     But 
nothing  was  more  needed  at  the  time  and  this  critique,  with 
its  dignified  message  of  hope  at  the  end,  established  certain 
norms  of  excellence  which  have  made  for  good  work  ever  since. 
The  address   which  Billings  delivered   at  the  International 
Medical  Congress  in  1881  was  reprinted  and  translated  in  most 
of  the  medical  journals  and  made  him  known  all  over  Europe. 
His  work  on  the  Johns  Hopkins  Hospital,  on  the  Index  Cata- 
logue, on  the  U.  S.  Census  and  his  many  publications  brought 
him  all  the  more  in  the  public  eye  in  this  country  and  made  him 
in  every  sense  of  the  word  a  leader  of  the  medical  profession. 
In  1886,  he  was  asked  to  represent  the  United  States  by  deliv- 
ering the  annual  address  in  medicine  at  the  meeting  of  the 
British   Medical   Association   at    Brighton,   England.     In   this 
address,  he  reviews  the  deficiencies  in  our  medical  organization 

408 


JOHN    SHAW    BILLINGS — GARRISON 

in  a  cheerfully  critical  wa}',  showing  that  even  in  1883  there 
were  "90,410  persons  calling  themselves  physicians"  in  the 
United  States  and  Canada,  ur  one  lo  every  589  persons  in  the 
United  States,  and  tliat  the  proportion  of  these  is  generally 
lowest  at  the  South  and  in  the  Southwest.  In  explanation  of 
this  fact,  he  produced  shaded  maps  showing  that  it  was  in  just 
these  regions  that  malarial  and  yelhnv  fevers  were  most  preva- 
lent, advanced  the  general  theorem  that  "malaria  and  science 
are  antagonistic,"  and  insisted  that  neither  "penal  nor  restrictive 
legislation"  could  induce  highly  educated  physicians  to  settle 
in  such  localities.  While  all  this  was  meant  as  a  joke,  since 
Billings  himself  admits  that  "it  was  within  the  limits  of  this 
malarial  shadow  that  the  foundation  of  modern  gynaecology 
was  laid  by  Marion  Sims,  of  abdominal  surgery  by  McDowell, 
Battey,  and  Gross,  of  an  important  part  of  the  physiology  of 
the  nervous  system  by  Campbell,"  nevertheless  the  bantering 
was  misinterpreted  as  an  expression  of  sectional  prejudice  by 
Southern  medical  editors,  particularly  in  connection  with  the 
curious  affair  of  the  approaching  International  Medical  Con- 
gress at  Washington  in  1887,  in  which  Billings  and  the  other 
committeemen,  appointed  at  Copenhagen  in  1884,  were  unjustly 
thrown  out  of  their  original  positions  by  the  American  Medical 
Association  at  the  New  Orleans  meeting,  May  8,  1884.  Dis- 
cussion of  this  imbroglio  has  no  place  here;  but  inasmuch  as 
the  trait  of  baiting  the  South  had  become  the  fashion  among 
our  superficial  people  during  the  Reconstruction  period  and 
after,  the  natural  attitude  of  the  Southerner  himself  towards 
the  old  South  being  touchy  and  sentimental,  like  that  of  the 
Catholic  nobles  toward  Mary  Stuart — 

"The  Queen  of   Scots  lived   gently   in   repute, 
She  has  much  wrong," 

Billings's  address  was  regarded  l)y  some  as  a  tactical  blunder. 
His  strictures  really  stimulated  the  South  to  better  efforts  ;  his 
apparently  hopeless  view  of  its  case  in  science  was  intended 
as  a  spur  and  an  incentive  ;  and,  at  the  conclusion  of  his  address 
at  the  o])ening  of  the  new  .\rmy  Medical  Museum  in  1887,  he 
urged  that  "the  nuiseuni  si)eciinens,  coining  as  they  do  from 
the  sick  and  woundeti  of  both  armies,  and  contributed  by  both 

409 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

Union  and  Confederate  surgeons,  enforce  the  lesson  of  the 
unity  of  the  profession  and  of  its  interests,  as  well  as  that  of 
our  country."  As  a  matter  of  fact,  the  ancient  Athenian  civili- 
zation was  developed  in  the  same  parallel  of  latitude  (38°  N.) 
as  the  once  malarial  Washington,  and,  although  many  writers 
assert  that  the  downfall  of  Greece  and  Rome  was  due  to  the 
introduction  of  malarial  fever,  yet  the  splendid  work  of  the 
Indian  Medical  Service  in  the  peninsula  of  Hindustan,  or  of 
such  southern  Americans  as  Walter  Reed  and  Gorgas  in  Cuba 
and  Panama,  shows  that  preventive  medicine  is  fast  overcom- 
ing the  restrictions  of  climate  and  of  tropical  diseases  upon 
scientific  productivity.  In  1900,  Billings  spoke  feelingly  of  the 
work  of  Walter  Reed,  who,  during  the  last  week  of  his  life, 
became  one  of  his  successors  as  librarian  of  the  Surgeon-Gen- 
eral's Office. 

On  June  i,  1896,  Billings  resigned  his  professorship  of 
hygiene  in  the  University  of  Pennsylvania  to  become  director 
of  the  New  York  Public  Library,  in  connection  with  the  pro- 
posed consolidation  of  the  Astor,  Lenox  and  Tilden  founda- 
tions. Here  his  unique  administrative  abilities  were  to  find 
widest  scope.  In  the  complex  legal  and  political  details  of 
selecting  and  securing  a  proper  site  for  the  proposed  new 
building  and  the  proper  appropriations  for  its  maintenance,  he 
played  an  important  part,  and  the  original  plan  of  the  structure, 
which  was  but  little  modified  in  the  end,  was  sketched  out  with 
his  own  hand  at  Atlantic  City  on  April  5,  1897,  and  exists  in 
two  states  and  a  facsimile  reproduction.^ 

"In  essence  the  plans  there  set  down  are  those  of  the  building 
as  it  stands  today,  the  stack  at  the  rear,  main  reading  room  on  top, 
other  rooms  and  offices  grouped  around  the  two  courts.  From  the 
issue  of  preliminary  notice  to  the  competitors  until  the  building  was 
finished  and  opened  fourteen  years  later  the  hand  of  Dr.  Billings  fol- 
lowed closely  every  development  of  plan  on  the  architect's  drawing- 
board  and  every  translation  of  it  into  the  brick  and  mortar,  iron  and 
wood  of  the  workman.  To  him  more  than  to  any  other  individual 
must  be  given  credit  for  the  plan  and  arrangement  of  the  present  build- 
ing, this  in  no  way  detracting  from  the  credit  due  to  Messrs.  Carrene 
and  Hastings  for  their  able  services  as  architects.** 


For  which  see  Library  Journ.,  N.  Y.,  191 1,  xxxvi,  238. 
'  H.  M.  lyydenberg,  Bull.  New  York  Pub.  Library,  1913,  xvii,  310. 

410 


JOHN    SHAW    RILLINCS — CARRISON 

At  the  laying  of  the  corner-stone.  November  ii,  1902,  Mr. 
John  Bigelow,  President  of  the  Board  of  Trustees,  said:  "I 
should  fail  of  my  duty  if  I  did  not  here,  on  behalf  of  the 
Board  of  Trustees,  publicly  recognize  our  incalculable  obliga- 
tions to  Dr.  J.  S.  Billings,  who  seems  to  have  been  providen- 
tially sent  to  conduct  the  executive  affairs  of  the  new  corpo- 
ration." On  May  23,  191 1,  the  new  building,  one  of  the  finest 
and  best  appointed  of  modern  public  libraries,  was  formally 
opened  to  the  public.  As  Mr.  Edwin  IT.  Anderson,  the  pres- 
ent Director  of  the  New  York  Public  Library,  has  said.  Dr. 
Billings  was  "in  a  very  real  sense  its  creator."  Of  the  gigantic 
administrative  achievement  which  is  to  be  credited  to  Billings 
during  the  seventeen  years  of  his  directorate  of  this  library, 
there  is  no  better  account  than  that  given  by  its  Reference 
Librarian,  Mr.  H.  ]\L  Lydenberg: 

"In  those  days  both  the  Astor  and  the  Lenox  buildings  closed  at 
three  or  four  o'clock  in  winter  and  at  five  or  six  during  the  rest  of  the 
year ;  each  closed  for  three  entire  weeks  in  the  summer.  The  com- 
bined staff  numbered  but  forty  people.  Neither  library  had  a  complete 
general  catalogue  or  a  shelf  list.  The  new  library  had  no  provision 
for  home  use  of  books,  this  work  being  carried  on  by  some  dozen 
independent  agencies. 

"Acting  on  the  recommendation  of  Doctor  Billings  when  he  took 
active  charge  of  the  work  in  the  summer  of  1896,  the  trustees  enlarged 
the  staff,  put  electric  light  in  both  buildings,  extended  the  hours  of 
closing  to  six  o'clock  througiiout  the  year. 

"The  combined  collections  contained  about  350,000  volume?,  classified 
by  fixed  location  and  incompletely  catalogued.  A  system  of  relative 
classification  was  devised  by  Doctor  Billings  and  under  his  direction 
applied  to  the  entire  collection.  A  uniform  system  of  cataloguing  was 
adopted  for  both  buildings ;  for  each  a  public  catalogue  was  provided 
in  dictionary  form  on  standard  size  cards.  With  these  catalogues  were 
combined  as  rapidly  as  possible  the  catalogues  previously  existing,  some 
of  which  were  printed  in  book  form,  some  in  manuscript  on  standa-'d 
cards,  some  in  manuscript  on  large  cards  and  some  on  small  cards. 

"As  executive  officer  of  the  trustees  he  arranged  a  system  of  co- 
operation with  the  other  large  libraries  of  the  city,  a  limitation  of  the 
field  of  each,  a  prevention  of  useless  duplication  of  effort.  With  the 
place  of  The  New  York  Public  Library  thus  defined  he  threw  his 
extensive  experience  in  the  book  trade,  his  widespread  and  minute 
knowledge  of  books  and  his  boundless  physical  and  mental  energy  into 
the  work  of  extending  and  completing  the  collections  of  the  library. 
Subscriptions  to  current  periodicals  were  doubled  and  trebled,  the  con- 

411 


NATIONAL   ACADEMY    BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

tents  of  the  important  magazines  were  represented  in  the  public  cata- 
logue by  index  cards,  a  co-operative  indexing  of  the  less  popular  maga- 
zines was  begun  in  connection  with  four  or  five  other  large  reference 
libraries. 

"The  activities  of  the  library  were  enlarged  in  many  ways.  Depart- 
ments of  maps,  music,  manuscripts,  and  prints  were  established  and 
put  on  firm  basis.  A  system  of  staff  meetings  were  begun  for  informal 
discussion  of  questions  of  policy  and  administration,  for  improving  the 
acquaintance  of  the  members  of  the  staff,  for  increasing  the  loyalty 
and  solidarity.  A  monthly  'Bulletin'  was  started  as  a  medium  of  in- 
formation about  the  work  of  the  institution,  its  growth  and  progress, 
the  help  it  offered  students  and  scholars. 

"The  first  five  years  of  his  life  with  The  New  York  Public  Library 
saw  the  staff  well  organized,  the  usefulness  of  the  institution  increased 
many  fold,  its  collections  more  than  doubled,  their  use  intensified,  new 
life  and  energy  in  every  member  of  the  staff. 

"His  next  achievement  was  the  consolidation  of  the  New  York  Free 
Circulating  Library  with  its  eleven  branches,  the  establishment  of  the 
circulation  department,  the  securing  of  the  gift  of  $5,200,000  from  Mr. 
Carnegie  for  circulation  branches,  and  the  union  of  practically  all  the 
circulating  systems  in  the  city."  " 

In  his  work  of  upbuilding  The  New  York  PubHc  Library, 
Bilhngs  was  materially  assisted  by  the  sagacious  counsel  of  his 
friend  Mr.  John  L.  Cadwalader.  late  president  of  its  board  of 
trustees,  and  by  the  loyal  support  of  his  co-workers  in  the 
institution.  The  report  of  the  library  for  1916  shows  that  it 
now  contains  2,459,996  books  and  pamphlets ;  that  it  has,  be- 
sides its  monumental  central  building,  43  branch  libraries  (37 
of  which  were  erected  from  funds  supplied  by  Mr.  Carnegie), 
32  in  the  Borough  of  Manhattan,  7  in  the  Bronx,  and  4  in 
Richmond,  and  that  the  total  number  of  its  employees  has  in- 
creased from  732  in  1910  to  1,224  in  1916.  In  his  selection  of 
Mr.  Anderson,  as  his  successor  in  this  library,  Billings  showed 
as  everywhere  his  keen  surety  of  judgment  in  estimating  the 
moral  and  administrative  capacities  of  men. 

Dr.  Billings  was  one  of  the  original  incorporators  of  the 
Carnegie  Institution  of  Washington  (January  4,  1902),  vice- 
chairman  of  its  Board  of  Trustees  up  to  December,  1903,  after 
which  he  was  chairman  until  his  death  and  a  member  of  the 
executive  committee.     He  missed  only  one  meeting  of  the  Board 

^^  Ibid.,  309-310. 

412 


.TOIIX    SlIAW    HII.I.IXGS — r.ARRISdN 

of  Trustees  and  attended  all  hut  thirteen  out  of  ninety-nine 
meetings  of  the  executive  committee  (1902-13).  During  this 
period,  Dr.  Billings  secured  the  revival  of  the  Index  Mcdiciis, 
with  Dr.  Fletcher  as  editor-in-chief  (1903),  was  a  strong  sup- 
porter of  the  Nutrition  Laboratory  (erected  in  Boston,  1907-8). 
the  Solar  Observatory  (erected  1905-6),  the  Department  of 
Meridian  Astrometry,  the  Department  of  Historical  Research, 
the  Department  of  Experimental  Evolution  and  the  Index  to 
State  Documents.  In  his  advisory  relation  to  the  institution 
he  had,  as  President  Woodward  has  testified,  the  necessary 
sense  of  humor  and  proportion,  the  breadth  of  learning,  the 
high  courage  and  fearless  detachment  of  mind  which  availed 
to  make  his  services  of  incalculable  value  to  the  institution 
during  its  formative  and  experimental  period.  The  early  ex- 
periences of  his  rugged  and  self-denying  youth  had  made  him 
perhaps  a  little  too  considerate  of  the  "sincere  but  deluded 
enthusiasts,"  the  self-appointed  genii  from  "the  long  grass  and 
the  tall  timber,"  who  pester  and  bullyrag  the  institution  with 
their  importunities  and  "inventions,"  but,  in  the  main,  he  sat 
securely  in  his  judgments,  and  he  was  loyal  and  consistent  in 
his  conviction  that  the  benefits  conferred  by  the  scientific  grants 
of  the  Institution  should  never  be  of  the  eleemosynary  kind. 

In  acknowledgment  of  the  value  of  his  work  in  science.  Dr. 
Billings  received  honorary  degrees  from  the  universities  of 
Edinburgh  (LL.  D.,  1884),  Harvard  (LL.  D.,  1886),  Oxford 
(D.  C.  L.,  1889),  Munich  (M.  D.,  1889),  Dublin  (M.  D.,  1892J, 
Budapest  (M.  D.,  1896),  Yale  (LL.  D.,  1901),  the  Johns  Hop- 
kins (LL.  D.,  1902).  and  was  an  active  or  honorary  member  in 
many  medical  and  scientific  societies.  On  April  17,  1883,  he 
was  elected  to  membership  in  the  National  Academy  of 
Sciences.  His  name  was  proposed  and  his  election  passed 
upon  mainly  on  the  strength  of  his  work  in  upbuilding  the 
Surgeon-General's  Library  and  its  Index  Catalogue,  which  Sir 
William  Osier  has  pronounced  his  "float  down  to  posterity,'' 
which  Professor  Welch  has  defined  as  the  most  important  con- 
tribution to  American  medicine  (as  distinguished  from  labora- 
tory and  clinical  contributions  to  the  different  branches  of  med- 
ical science)  in  the  nineteenth  century,  and  which  Professor 
Adami,  of  Canada,  has  declared  to  be  the  outstanding  produc- 

413 


NATIONAL,   ACADEMY    BIOGRAPHICAL    MEMOIRS VOL.  VIII 

tion  of  American  medicine  in  the  eyes  of  Europe.  He  was 
treasurer  of  the  Academy  from  1887  until  1898,  a  member  of 
the  council  (1896-1907),  of  various  committees,  such  as  that 
on  publications  (i888-'99),  and  one  of  the  trustees  of  the 
Barnard  Medal  Fund  (1900-1908).  During  the  last  years  of 
his  life  (1906-1912),  he  was  active  on  various  committees  for 
enlarging-  the  scope  of  membership  to  include  anthropologists, 
psychologists,  philologists,  etc.  In  1885,  he  presented  (with 
Washington  Matthews)  memoirs  on  composite  photographs  of 
skulls ;  in  i894-'5  the  researches  made  by  his  pupils  in  the 
Laboratory  of  Hygiene,  and  contributed  biographical  memoirs 
of  Joseph  Janvier  Woodward  (1885),  Spencer  F.  Baird 
(1889),  and  Francis  A.  Walker  (1902). 

In  public  and  military  hygiene,  in  hospital  construction  and 
sanitary  engineering,  in  the  mathematical  methods  of  vital  and 
medical  statistics,  Billings  was  an  actual  and  accomplished 
worker  in  applied  science,  using  the  term  in  the  restricted  sense 
of  man's  attempt  to  understand  natural  and  physical  phenom- 
ena in  order  to  predict  and  control  their  consequences.  In 
relation  to  the  loose  aggregation  of  sciences  which  goes  under 
the  name  of  medicine,  he  was  essentially  the  masterful  pioneer, 
organizer,  and  administrator,  and  no  fair-minded  and  discrim- 
inating historian  of  medicine  in  the  future  can  fail  to  recognize 
him  as  the  man  of  his  generation  who  did  most  to  advance  the 
cause  of  higher  medical  education  and  of  the  general  literary 
status  of  scientific  medicine  in  this  country.  Withal  he  was 
a  man  of  singular  versatility,  widely  read  in  all  branches  of 
secular  and  scientific  literature,  particularly  in  such  subjects 
as  the  minute  fungi  and  the  mystic  and  theosophic  lore  of  the 
far  East.  His  quaint  sympathy  with  self-deluded  "inventors" 
may  perhaps  have  been  due  to  the  fact  that  he  was  an  inventor 
of  no  mean  capacity  himself.  In  1870,  he  devised  a  ventilating 
double-fireplace  for  army  barracks;  in  1881,  he  suggested  the 
possibility  of  obtaining  telegrams  and  phonograms  from  the 
heart,  which  was  brilliantly  realized  by  Waller,  Einthoven,  and 
others  during  1 889-1 903 ;  in  i884-'5,  he  devised  (with  Major 
Washington  Matthews)  a  method  of  taking  composite  photo- 
graphs of  skulls ;  in  1880  he  suggested  the  general  plan  for  the 
Jlpllerith  electrica)  counting  and  integrating  machines,  which 

414 


JOHN    SHAW    BILLINGS — GARRISON 

are  now  used  by  the  United  States  Census ;  he  devised  some 
of  the  tabulatinji^  methods  employed  in  vital,  medical,  and  mili- 
tary-medical statistics,  and  he  originated  the  methods  of  biblio- 
graphic technique  employed  in  the  Surgeon-General's  I^ibrar\- 
and  the  New  York  Public  Library.  As  an  organizer  and  ad- 
ministrator, he  carried  every  one  along  with  him  by  the  force  of 
his  ^^iking  personality,  but  to  his  personal  friends  and  to  his  co- 
workers, whom  he  bound  as  with  "hooks  of  steel"  to  himself, 
he  was  a  good  example  of  the  poet's  "great  individual,  fluid  as 
nature,  chaste,  affectionate,  compassionate,  fully  arm'd."  All 
along  the  line  he  upheld  the  honorable  Saxon  belief  that  the 
game  of  life  must  be  played  according  to  its  ethical  rules ;  but 
certain  traits  of  aggression  which  produced  the  superficial  im- 
pression of  hardness  were  known  to  his  intimates  to  be  due  to 
the  effects  of  internal  disease,  to  the  fact  that  "calculus  racked 
him,"  and  that  he  was  a  life-long  sufferer  from  the  cancerous 
diathesis.  He  was  eight  times  on  the  surgeon's  table — four 
times  for  major  operations — but,  as  in  the  case  of  a  fracture  of 
the  ribs  occasioned  by  the  jolting  of  a  railroad  car,  he  treated 
all  this  lightly  and  tried  to  conceal  it  from  his  wife  and  family. 
In  this  he  showed  the  Trogemot,  the  superb  courage  in  endur- 
ance, of  his  Scandinavian  ancestors.  His  friend,  the  late  Sir 
Lauder  Brunton,  said : 

"As  his  name  shows,  he  was  of  Scandinavian  ancestry,  and  he  re- 
tained the  overpowering  strength  and  energy  by  which  his  Berserker 
forefathers  carried  everything  before  them.  But  he  concealed  them 
under  such  a  quiet,  unassuming,  courtly  exterior  that  those  who  had 
only  a  casual  acquaintance  with  him  could  hardly  suspect  the  enormous 
latent  energy  he  possessed.  Though  his  learning  was  stupendous,  he 
never  obtruded  it,  but  along  with  an  easy  flow  of  language  and  a  quiet 
vein  of  humor  it  made  him  an  excellent  speaker  and  an  agreeable 
companion,  while  his  strong  nature,  affectionate  disposition,  and  kindly 
ways  rendered  him  at  the  same  time  beloved  and  trusted  by  those 
whom  he  honored  with  his  friendship." 

To  the  discriminating,  in  England  and  America,  Billings 
seemed,  in  personality,  a  great  (in  the  sense  of  an  absolutely 
reliable)  man.  Dr.  Welch  said:  "He  was  the  wisest  man  I 
ever  knew."  Colonel  Walter  D.  McCaw  (U.  S.  Army)  said: 
"He  undoubtedly  had  the  making  of  a  great  soldier,    He  would 

415 


NATIONAL   ACADEIMY   BIOGRAPHICAL    MEMOIRS — VOL.  VIII 

have  made  a  great  general.  He  would  have  made  a  most  able 
prime  minister,  and  he  would  have  had  his  own  way.  He 
would  undoubtedly  have  made  a  great  ruler,  probably  an  easier 
position  to  fill."  Mr.  J.  Y.  W.  MacAlister,  librarian  of  the 
Royal  Society  of  Medicine,  said  :  "He  was  a  great  man  in  every 
sense  of  the  word,  *  *  *  and  we  are  not  likely  to  look  upon 
his  like  again."  Of  his  position  among  his  medical  colleagues, 
Dr.  Jacobi,  the  Nestor  of  our  American  profession,  wrote : 

"He  was  not  really  'one  of  us,'  no  practitioner,  no  consultant,  not 
often  seen  in  medical  societies.  I  believe  there  are  many  of  the  younger 
men  who  never  saw  him.  But  all  knew  him,  knew  he  was  above  us. 
His  superior  position  was  recognized  by  every  one.  Everybody  knew 
he  had  rendered  and  was  constantly  rendering  services  unique  and 
such  as  nobody  else  could  render  or  imitate." 

And  again,  in  the  spirit  of  the  inscription  over  the  French 
Pantheon,  "Aux  grands  hommes  h  patric  reconnaissante," 
Jacobi  said: 

"We  trust  that  it  is  not  probable  that  the  light-heartedness  and  for- 
getfulness  of  an  ungrateful  republic  will  deal  with  his  memory  as  with 
that  of  lesser  men.  It  is  by  him  that  the  combination  of  American 
idealism  and  creative  constructiveness  is  best  represented,  an  example 
to  be  emulated  by  all  men,  both  great  and  small,  in  all  countries. 
*  *  *  His  life  itself,  ever  vigorous,  ever  modest,  ever  bountiful,  is 
his  eulogy." 


416 


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UL  suu  I  ntniM  ntuiuivHL  lidt 


'     e:rsity  of  calif        ||||||||||||||||||||||||||llllllllllllllilllllii 
58  008235425  LosAngei  ^A    001197  336    9 


Ff  B     8  Ja83 


BIC.-.U  FEB  2  2  "83 


Form  L9-100m-9,'52(A3105)444 


MAR  2  2  REM 


